[Federal Register Volume 60, Number 43 (Monday, March 6, 1995)]
[Notices]
[Pages 12220-12240]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-5409]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families and the Public Health Service
[Program Announcement No. OCS 95-12]
Family Violence Prevention and Services Program
AGENCY: Office of Community Services, Administration for Children and
Families; Centers for Disease Control and Prevention, Public Health
Service; and the Substance Abuse and Mental Health Services
Administration, Public Health Service; in the Department of Health and
Human Services (HHS).
ACTION: Notice of the availability of financial assistance and request
for applications to establish a National Domestic Violence Hotline.
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SUMMARY: The Office of Community Services, Administration for Children
and Families, in cooperation with the Centers for Disease Control and
Prevention and Substance Abuse and Mental Health Services
Administration, announces the availability of funds in fiscal year 1995
for the award of one cooperative agreement on a competitive basis to
operate a national, toll-free telephone hotline to provide information
and assistance to victims of domestic violence. This announcement
contains all of the application materials needed to apply for this
cooperative agreement.
The purpose of the national domestic violence hotline is to provide
information and referral services, counseling, and assistance to
victims of domestic violence, their children and other family members,
and others affected by such violence and to enable them to find safety
and protection in crisis situations. The successful applicant will be
required to provide telephonic assistance on a 24 hour-per-day, seven
day-a-week basis throughout the continental United States, and in
Alaska, Hawaii, the Commonwealth of Puerto Rico, and the Virgin
Islands.
DATES: The closing date for submission of applications is June 5, 1995.
ADDRESSES: Applications may be mailed to the Department of Health and
Human Services, Administration for Children and Families/Division of
Discretionary Grants, 370 L'Enfant Promenade, SW., 6th Floor, (OCS 95-
12) Washington, DC. 20447.
Hand delivered applications are accepted during the normal working
hours of 8 a.m. to 4:30 p.m., Monday through Friday, on or prior to the
established closing date at:
Administration for Children and Families, Division of Discretionary
Grants, 901 D Street, SW., 6th Floor (OCS 95-12), OFM/DDG, Washington,
DC 20447.
FOR FURTHER INFORMATION CONTACT: William D. Riley, Administration for
Children and Families, Office of Community Services, Division of State
Assistance, 370 L'Enfant Promenade, S.W., Washington, DC. 20447.
Telephone (202) 401-5529.
SUPPLEMENTARY INFORMATION: This program announcement consists of four
parts. Part I provides information on the legislative authority
applicable to this announcement and background information on the
proposed national domestic violence hotline. Part II describes the
minimum requirements for the design of the hotline that the applicant
must address in its application. Part III describes the evaluation
criteria. Part IV provides information and instructions for the
development and submission of an application.
The forms to be used for submitting an application follow Part IV.
Please copy and use these forms in submitting an application under this
announcement. No additional application materials are available or
needed to submit an application.
Applicants should note that the cooperative agreement to be awarded
under this program announcement is subject to the availability of
funds.
Part I: General Information
A. Legislative Authority
Title III of the Child Abuse Amendments of 1984, (Pub. L. 98-457,
42 U.S.C. 10401, et seq.) is entitled the Family Violence Prevention
and Services Act (the Act). The Act was first implemented in FY 1986,
was reauthorized and amended in 1992 by Pub. L. 102-295, and was
reauthorized and amended for fiscal years 1996 through 2000 by Pub. L.
103-322, the Violent Crime Control and Law Enforcement Act of 1994
(Crime Bill), signed into law on September 13, 1994.
One part of the Crime Bill, the Violence Against Women Act, added
section 316 to the Family Violence Prevention and Services Act to
authorize a grant award for up to five years to provide for the
operation of a national, toll-free telephone hotline to provide
information and assistance to victims of domestic violence.
B. Conceptual Framework and Scope of Services
The prevalence of family violence is widespread and its effective
prevention and treatment requires coordination and collaboration among
a broad range of legal, justice system, health, and social service
providers, and advocates at the Federal, State and local levels.
To serve the wide range of expected calls effectively, the hotline
must have expertise about domestic violence and services to victims of
domestic violence. The staff also must understand the importance of
using appropriate linkages with State and local resources to serve
callers to the hotline. The benefits of a highly visible national
hotline to victims and others will be directly related to the
productive working relationships and coordinated provision of services
between and among the hotline and State and local hotlines and other
services and resources.
Calls to the hotline may range from the urgent and life-threatening
to calls for general reference information. The target population to be
served by the hotline is specified in the statute as ``victims of
domestic violence.'' The hotline should be prepared to respond to the
broad range of violence that [[Page 12221]] occurs in the context of
family and intimate relationships, domestic violence, spouse abuse,
partner abuse, battering of women, sexual assault, date rape, and
acquaintance rape. The hotline also will serve those less directly
affected by such abuse, e.g., relatives, children of victims and other
family members, friends, neighbors, perpetrators and batterers, other
concerned individuals, and the general public.
In terms of the scope of the services provided by the hotline, the
statute requires the provision of ``information and assistance'' and
``counseling and referral services.'' Therefore, the applicants'
proposed design and plan for operating the hotline and responding to
callers is important. However, the hotline is not expected to provide
extended or long-term counseling or therapy services. The fuller
discussion of a problem and consideration of options is done most
appropriately at the local level, given the variation in laws and
services available among the States and localities.
Finally, because domestic violence often contributes to isolation,
helplessness, loss of self-esteem, and dependence, a self-help and
empowerment model of services is needed. Such a model:
Protects and assures safety for all victims and other
family members;
Builds on the strengths and resources of individuals and
families;
Offers options and support for independent decision-making
based on specific individual and family needs and circumstances; and
Assists individuals and families to obtain protection and
needed services that are respectful of cultural and community
characteristics.
Finally, we recognize that there is an inter-relationship between
alcohol, drug abuse, and mental health (ADM) problems and domestic
violence. Alcohol abuse has been demonstrated to contribute to violent
behavior. Moreover, the abuse of alcohol coupled with other drugs is
even more likely to be associated with severe battering incidents than
is alcohol by itself. Victims of and or witnesses to domestic violence
also may experience psychological consequences or turn to substance to
ameliorate their pain. In addition to physical trauma resulting from
acts of physical abuse, battered women suffer from a number of mental
health consequences, including higher levels of depression, drug and
alcohol abuse, suicide attempts, and low self-esteem. Many of the
mental health consequences of spousal violence result from chronic
intimidation and fear, which are often as significant as the actual,
acts of physical aggression. Witnessing spousal violence contributes to
the cycle of violence outside the home. There is an increased
likelihood of child abuse in homes where there has already been spouse
abuse.
C. Eligible Applicants
Any private nonprofit agency, organization, institution, Tribal
organization, or combination thereof, is eligible to apply for these
funds. Any nonprofit organization submitting an application must submit
proof of its nonprofit status in its application at the time of
submission. The non-profit agency can accomplish this by providing a
copy of the applicant's listing in the Internal Revenue Service's (IRS)
most recent list of tax-exempt organizations described in Section
501(c)(3) of the IRS Code or by providing a copy of the currently valid
IRS tax exemption certificate, or by providing a copy of the articles
of incorporation bearing the seal of the State in which the corporation
or association is domiciled.
D. Availability of Funds
As authorized by section 316 of the Act, the Office of Community
Services will award one cooperative agreement in FY 1995 of a maximum
of $1 million for the implementation of the toll-free rational domestic
violence hotline. The source of these funds will be the Crime Bill
Trust Fund.
Non-competitive continuation grant awards for each of years two
through five (FYs 1996-1999) will be a maximum of $850,000, subject to
the availability of funds. This total represents $400,000 from the
Crime Bill Trust Fund for the operation of the hotline and $450,000 to
be used to carry out additional statutory and programmatic activities
on behalf of the Centers for Disease Control and Prevention (CDC), the
Substance Abuse and Mental Health Services Administration (SAMHSA), and
the Office of Community Services (OCS).
Because the national hotline is viewed as a viable mechanism to
achieve a number of specific aims, in each of years two through five
CDC plans to provide $250,000 under section 393 of the Public Health
Services Act to provide additional support for State and local domestic
violence hotlines in response to the demand generated by the national
public awareness campaign; SAMHSA plans to provide $100,000 under
appropriate FY 1996 statutory authorities to enhance the hotline
database to include ADM resources, support the training of hotline
staff to assure that they are knowledgeable about ADM involvement in
incidents of domestic violence and can make appropriate referrals to
ADM services, and, to the extent possible, collect such information
from callers; and OCS plans to provide $100,000 under section 305 of
the Family Violence Prevention and Services Act to support additional
compilation and reporting of information based on calls to the hotline.
These supplemental activities are described in greater detail as
grantee requirements in Part II of this announcement.
Section 316 of the Act also states that funds appropriated and
awarded from the Crime Trust Fund will remain available until expended,
i.e., the $1 million in FY 1995 and $400,000 in FYs 1996-1999. This
provides additional flexibility to the grantee in the timing and use of
these funds. The funds for additional purposes in FYs 1996-1999
($450,000 in each of years two through five) must be expended by the
end of the fiscal year following receipt of the funds.
E. Duration of Project
The Office of Community Services, in cooperation with CDC and
SAMHSA, will award one grant, as a cooperative agreement, for up to
five years (60-month project period). The initial grant award, to be
made on a competitive basis, will cover a 12-month budget period.
Application for continuation funding beyond the initial 12-month budget
period, but within the 60-month project period, will be considered in
subsequent years on a non-competitive basis, subject to the approval of
the Secretary, the availability of funds, the satisfactory performance
of the grantee, and the determination that the continued funding and
support of the project would be in the best interest of the government.
F. Cooperative Agreement
The Office of Community Services intends to support the national
toll-free hotline through a cooperative agreement. A cooperative
agreement is Federal financial aid in which substantial Federal
involvement is anticipated. The responsibilities of the Administration
for Children and Families and of the successful applicant will be
identified and incorporated into the cooperative agreement during pre-
award negotiations. It is anticipated that ACF responsibilities will
not change the project requirements found in Part II of this
announcement.
The grantee will outline a plan of interaction with OCS for
implementation under a cooperative [[Page 12222]] agreement including,
as appropriate, activities involving Federal staff. The plan under the
cooperative agreement will describe the general and specific
responsibilities of the grantee and the grantor as well as foreseeable
joint responsibilities. A schedule of tasks will be developed and
agreed upon in addition to any special conditions relating to the
implementation of the hotline.
G. Grantee Share of the Project
The grantee must provide at least 25 percent of the total approved
cost of the project. The total approved cost of the project is the sum
of the Federal share and the non-Federal share. The non-Federal share
may be met by cash or in-kind contributions, although applicants are
encouraged to meet their match requirements through cash contributions.
Therefore, a project requesting $1,000,000 in Federal funds for the
first year budget period must include a match of at least $333,333 (25
percent of total project cost). If approved for funding, the grantee
will be held accountable for commitments of non-Federal resources, and
failure to provide the required amounts will result in a disallowance
of unmatched Federal funds.
Part II: Project Requirements
Requirements for Project Implementation
The following requirements must be met by the grantee and addressed
in the application:
1. All funds received by the grantee pursuant to Section 316 of the
Act must be used to establish and operate a national toll-free,
telephone hotline to provide information and assistance to victims of
domestic violence.
2. In establishing the hotline, the private, nonprofit entity
shall--
Contract with a carrier for the use of a toll-free
telephone line;
Employ, train, and supervise personnel to answer incoming
calls and provide counseling and referral services on a 24-hour-a-day
basis;
Assemble and maintain a current database of information
relating to services for victims of domestic violence to which callers
may be referred throughout the United States, including information on
the availability of shelters that serve battered women and their
children; and
Publicize the hotline to potential users throughout the
united States.
3. To be approved by the Secretary, the application must include a
complete description of the applicant's plan for the operation of a
national domestic violence hotline, including description of--
The training program for hotline personnel;
The hiring criteria for hotline personnel;
The methods for the creation, maintenance, and updating of
a resource database;
A plan for publicizing the availability of the hotline;
A plan for providing service to non-English speaking
callers, including hotline personnel who speak Spanish; and
A plan for facilitating access to the hotline by persons
with hearing impairments.
4. The applicant must demonstrate that it has:
Nationally recognized expertise in the area of domestic
violence and a record of high quality service to victims of domestic
violence, including a demonstration of support from advocacy groups,
such as domestic violence State coalitions or recognized national
domestic violence groups; and
A commitment to diversity, and to the provision of
services to ethnic, racial, and non-English speaking minorities, in
addition to older individuals and individuals with disabilities.
5. The applicant must demonstrate knowledge of the field, including
the range of services and the resources available for domestic violence
victims, their children and family members, perpetrators and batterers,
and other concerned individuals, including services and resources
relating to substance and mental health problems; State and Indian
tribal domestic violence laws, including the availability of legal
protection; and the barriers affecting access to such services,
resources and protection.
6. The applicant must demonstrate experience in providing high-
quality crisis intervention, information and referral, and counseling
services and support to battered women, their children, other domestic
violence victims, their family and friends, batterers, and the general
public.
7. The applicant must demonstrate an understanding of the
relationship of alcohol, drug abuse, and mental health (ADM) problems
to incidents of domestic violence and the ability to make appropriate
referrals to callers.
8. The applicant must demonstrate an understanding of the need for
a national hotline for domestic violence victims, including a
description of the function and limitation of the current network of
national and State crisis hotlines, information lines, and State
victims referral services.
9. The applicant must provide a plan and demonstrated ability to
build, maintain, and keep current a comprehensive database of resource
information, including the full range of services available in local
communities, the types of legal protection and services available in
different States and localities, and the capability to access
information.
10. The applicant must provide a detailed description of:
The telecommunications and computer technology that will
be employed to establish and support the hotline, including all
management functions, referral functions, resource database management
functions, monitoring functions, and overall project administration and
quality control, including periodic reporting to HHS;
The design and operation of the telephone system that will
be used to provide the service; its capacity and its limitations,
including information such as the capacity to facilitate the number of
incoming calls, call conferencing, automatic call referral to local
providers, and service integration with computers.
The methods that will be used to ensure that the national
hotline is a confidential crisis intervention and the specific
provisions that will be in place to safeguard the confidentiality of
callers and ensure the proper handling of confidential or sensitive
information;
The personnel recruitment, hiring, and training program
(i.e., a description of an initial and ongoing training plan for staff
and volunteers should be included in this section) that will ensure the
delivery of quality crisis intervention, information and referral,
assistance, and counseling services to diverse populations;
The specific emergency response and crisis protocol to be
used, the ability to conference call (or ``patch'') a caller to a local
domestic violence, legal services, or mental health or substance abuse
program when appropriate, and the plans for minimizing such problems as
crank/obscene calls and busy signals; and
The methods the applicant will use to provide for the
development, maintenance, and updating of a comprehensive resource
database (distributed to the maximum extent appropriate); the technical
capacity to link with other State and local databases in order to
maintain an extensive and current resource locator or listing; the
ability to facilitate communication among service providers to assist
the [[Page 12223]] provision of services; and how the information on
best practices gathered through the inventory being conducted by CDC
will be used to assist victims. 11. The applicant must demonstrate an
understanding of the technological requirements of such a project and
include a detailed timeline to provide the following services
nationally:
24-hour/365 days per year access;
Direct access to English and Spanish-speaking personnel at
all times and provision for services to other non-English speaking
callers and the hearing impaired;
Personnel (paid staff and volunteers) trained in crisis
intervention, information and referral, and counseling skills;
Comprehensive database of current information;
The ability to connect callers directly to local programs
or services when appropriate;
Emergency response protocol for callers in immediate
danger; and
Appropriate confidentiality safeguards; and data
collection and data management capability sufficient to support program
administration, reporting, monitoring, and an ongoing quality
assessment of the hotline service.
12. The applicant must provide a plan to coordinate, work with, and
provide hotline services and data resource and referrals that make
maximum use of existing domestic violence programs and resources,
including, but not limited to, local and State-wide domestic violence
hotlines, State Domestic Violence Coalitions, shelter programs,
emergency services, legal services programs, national domestic violence
resource centers, other existing national hotlines, and other national
organizations; resources related to child abuse and youth endangerment,
ADM problems, and perpetrators and batterers programs, the national
domestic violence media campaign coordinated by the Family Violence
Prevention Fund, and the various activities of the Centers for Disease
Control under its campaign to prevent violence against women. The
applicant must provide support to State and local domestic violence
hotlines in response to the demand generated by the national public
awareness campaign.
13. The applicant must provide a description of the quality
assurance system it will use to assess regularly the quality of the
services being provided by the hotline and the extent to which the
goals and objectives of the service are being met. The quality
assurance system also must include actions to address identified
problems.
14. The applicant must provide a comprehensive plan to publicize
the hotline to a wide national audience, including efforts to ensure
promotion through the national media and through targeted outreach to
racially and ethnically diverse communities, older individuals, and
individuals with disabilities.
15. The applicant must demonstrate the ability to staff,
financially support, and programmatically administer a national project
of this scope.
16. The author(s) of the application must be clearly identified
together with a description of his or her current relationship to the
applicant organization and any future project role he or she may have
if the project is funded.
17. The applicant must provide an assurance that any information
collected as a part of this grant will become the property of the
Federal Government.
18. The applicant must provide an assurance that it will work with
the Federal Project Officer to identify the information that will be
compiled based on incoming calls including compilation of information
on both maternal and child victims of domestic violence and individual
and situational factors characterizing violent and abusive behavior.
19. The applicant must provide an assurance that it will comply
with the grant administration requirements in 45 CFR part 74.
Part III: Evaluation Criteria
The five criteria that follow will be used to review and evaluate
how each application has addressed the requirements stated in Part II
and should be used in developing the program narrative. The point
values following each criterion heading indicate the maximum numerical
weight that each section will be given in the review process.
1. Need for the Project (10 Points)
Provide a detailed discussion of the need for a national domestic
violence hotline of the scope being proposed. Provide a detailed
analysis of the available data related to the problem being addressed
(both domestic violence in general and the specific lack of a national
domestic violence hotline); the strengths and limitations of other
national and local crisis intervention and victim services hotline/
referral services available, and the ``state-of-the-art'' relative to
the problem being addressed by the proposal.
2. Goals and Objectives (10 Points)
Clearly state the project goals and objectives. Objectives should
be stated in concrete, measurable terms which clearly identify the
population(s) to be served, the type, quality, and level of service to
be provided, the timeline for the establishment and delivery of
services, and other project benchmarks. The anticipated demand for
hotline services during the initial start-up period and a projection of
the demand on an ongoing basis should be discussed, with supporting
documentation. Describe the precise location of the project.
3. Approach (30 Points)
Provide a sound workable plan of action (approach) which details:
how the proposed work will be accomplished; how each task relates to
the project's goals and activities; identifies the key staff member
responsible for the specific tasks; provides a chart indicating the
timetable for completing each task, the phasing in of the tasks over
time, the lead staff person, and the time committed to the task; cites
factors which might accelerate or decelerate the work; justifies the
approach selected over other approaches; makes maximum use of existing
facilities and resources and off-the-shelf technology; describes and
supports any unusual features of the project, such as design or
technological innovations, reductions in cost or time, or extraordinary
social or community involvement; and provides projections of the
accomplishments to be achieved and identifies the activities for which
Federal technical assistance, advice, or guidance as the project is
implemented is anticipated and would be acceptable.
4. Results and Benefits Expected (20 Points)
Identify, in specific terms, the results and benefits to be derived
from the project and relate each result and benefit to a specific
objective. Indicate the aggregate number of calls expected to be
received and individuals to be assisted on an annual basis, e.g., the
expected volume of calls in such service areas as crisis counseling,
immediate referrals to shelters, or the number of referrals made in
response to non-English speaking callers. Indicate the anticipated
impact on and the subsequent benefit of the national hotline to victims
of domestic violence and on the existing network of State and local
shelters and services. Identify the kinds of data to be collected,
maintained, and updated, and discuss [[Page 12224]] the criteria to be
used to assure the quality of the services provided.
5. Level of Effort (30 Points)
Expertise, Commitment, and Support. The extent to which the
applicant has nationally recognized expertise in the area of domestic
violence and a record of high quality service to victims of domestic
violence, including a demonstration of support from advocacy groups,
such as State Domestic Violence Coalitions or recognized national
domestic violence groups; the extent of the applicant's commitment to
diversity, and to the provision of service to ethnic, racial, and non-
English speaking minorities, older individuals, and individuals with
disabilities.
Staff Background and Organizational Experience. The adequacy of the
staffing pattern for the proposed project, how the individual
responsibilities are linked to project tasks, and the contributions to
be made by key staff. Each collaborating or cooperative organization,
individual consultant, or other key individuals who will work on the
project should be listed along with a description of the nature of
their effort or contribution.
Competence of Staff. The background and experience of the project
director and key project staff and the history and accomplishments of
the organization; the qualifications of the project team including any
experience with similar projects; the variety of skills, relevant
educational background, and the ability to effectively manage the
project and to coordinate activities with other agencies. One or two
pertinent paragraphs on each key member are preferred to vitae/resumes.
However, vitae/resumes may be included.
Adequacy of Resources. The adequacy of the available resources and
organizational experience with regard to the tasks of the proposed
project. List the financial, physical, and other resources already
committed by other public and private agencies and institutions, if
any. Explain how these organizations will participate in the day to day
operations of the project. Letters from these agencies and
organizations identifying and discussing the specifics of their
commitment and participation must be included in the application.
Budget. Relate the proposed budget to the level of effort required
to obtain the project objectives. Demonstrate that the project's costs
are reasonable in view of the anticipated results.
Collaborative Efforts. The additional anticipated private sector
resources that may be available to support or enhance the overall
program. Discuss in detail and provide documentation for any proposed
collaborative or coordinated efforts with other public and private
agencies or organizations. Identify these agencies or organizations and
explain how their participation will enhance the project. Letters from
these agencies and organizations must be included discussing their
interest and/or commitment in supporting this project, the stage of the
planning and decision-making, and the expected level of resource
commitment.
Part IV: Instructions for the Development and Submission of
Applications
This Part contains information and instructions for submitting
applications in response to this announcement. Application forms are
provided as part of this publication along with a checklist for
assembling an application package. Please copy and use these forms in
submitting an application.
Potential applicants should read this section carefully in
conjunction with the information describing the proposed project under
which the application is to be submitted. The project design
requirements are found in Part II.
A. Required Notification of the State Single Point of Contact
This program is covered under Executive Order 12372, (E.O.)
``Intergovernmental Review of Federal Programs,'' and 45 CFR Part 100,
``Intergovernmental Review of Department of Health and Human Services
Program and Activities.'' Under the E.O., States may design their own
processes for reviewing and commenting on proposed Federal assistance
under covered programs.
All States and territories, except Alabama, Alaska, Colorado,
Connecticut, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana,
Nebraska, Oklahoma, Oregon, Pennsylvania, South Dakota, Virginia,
Washington, American Samoa, and Palau, have elected to participate in
the E.O. process and have established Single Points of Contact (SPOCs).
Applicants from these nineteen jurisdictions need take no action
regarding E.O. 12372. Otherwise, applicants should contact their SPOCs
as soon as possible to alert them of the prospective applications and
receive any necessary instructions. Applicants must submit any required
material to the SPOCs as soon as possible so that OCS can obtain and
review SPOC comments as part of the award process. It is imperative
that the applicant submit all required materials, if any, to the SPOC
and indicate the date of this submittal (or the date of contact if no
submittal is required) on the Standard Form 424, item 16a.
Under 45 CFR 100.8(a)(2), a SPOC has 60 days from application
deadline to comment on proposed new or competing continuation awards.
SPOCs are encouraged to eliminate the submission of routine
endorsements as official recommendations. Additionally, SPOCs are
requested to differentiate clearly between mere advisory comments and
those official State process recommendations which may trigger the
``accommodate or explain'' rule.
When comments are submitted directly to ACF, they should be
addressed to: Department of Health and Human Services, Administration
for Children and Families, Division of Discretionary Grants, (OCS-95-
12) 370 L'Enfant Promenade, SW., 6th Floor, Washington, DC 20447.
A list of the Single Points of Contact for each State and Territory
is included at the end of this announcement.
B. Deadline for Submittal of Applications
The closing date for submittal of applications under this program
announcement is found at the beginning of this program announcement
under DATES. Applications shall be considered as meeting the announced
deadline if they are either:
1. Received on or before the deadline date at the Department of
Health and Human Services, Administration for Children and Families,
Division of Discretionary Grants, (OCS-95-12) 370 L'Enfant Promenade,
SW., 6th Floor, Washington, DC 20447, or
2. Sent on or before the deadline date and received by OCS in time
to be considered during the competitive review process.
Applications must be postmarked no later than the date to be found
at the beginning of the Program Announcement under DATES. When mailing
application packages, applicants are strongly advised to obtain a
legibly dated receipt from a commercial carrier (such as UPS, Federal
Express, etc.) or from the U.S. Postal Service as proof of mailing by
the deadline date. Private metered postmarks are not acceptable as
proof of timely mailing.
Late applications. Applications which do not meet the criteria
under ``Deadlines'' are considered late applications. The ACF shall
notify each late applicant that its application will not be considered
in the current competition.
Extension of deadlines. The ACF reserves the right to extend the
deadline [[Page 12225]] for all applicants due to acts of God, such as
floods, hurricanes or earthquakes; if there is widespread disruption of
the mail; or if ACF determines a deadline extension to be in the best
interest of the Government. However, ACF will not waive or extend the
deadline for any applicant unless the deadline is waived or extended
for all applicants.
C. Instructions for Preparing the Application and Completing
Application Forms
The SF 424, SF 424A, Page 2, and the required certifications have
been reprinted for your convenience in preparing the application. You
should reproduce single-sided copies of these forms from the reprinted
forms in the announcement, typing your information onto the copies.
Please do not use forms directly from the Federal Register
announcement, as they are printed on both sides of the page.
In order to assist applicants in correctly completing the SF 424
and SF 424A, instructions for these forms are included below.
Where specific information is not required under this program, NA
(not applicable) has been preprinted on the form.
Please Prepare Your Application in Accordance With The Following
Instructions:
1. SF 424 Page 1, Application Cover Sheet
Please read the following instructions before completing the
application cover sheet. An explanation of each item is included.
Complete only the items specified.
Top of Page! Enter designation ``HTL.''
Item 1! ``Type of Submission''--Preprinted on the form.
Item 2! ``Date Submitted'' and ``Applicant Identifier''--Date
application is submitted to ACF and applicant's own internal control
number, if applicable.
Item 3: ``Date Received By State''--State use only (if applicable).
Item 4: ``Date Received by Federal Agency''--Leave blank.
Item 5: ``Applicant Information'' ``Legal Name''--Enter the legal
name of applicant organization.
``Organizational Unit''--Enter the name of the primary unit within
the applicant organization which will actually carry out the project
activity. Do not use the name of an individual as the applicant. If
this is the same as the applicant organization, leave the
organizational unit blank.
``Address''--Enter the complete address that the organization
actually uses to receive mail, since this is the address to which all
correspondence will be sent. Do not include both street address and
P.O. box number unless both must be used in mailing.
``Name and telephone number, including the area code, of the person
to be contacted on matters involving this application ``--Enter the
full name (including academic degree, if applicable) and telephone
number of a person who can respond to questions about the application.
This person should be accessible at the address given here and will
receive all correspondence regarding the application.
Item 6: ``Employer Identification Number (EIN)''--Enter the
employer identification number of the applicant organization, as
assigned by the Internal Revenue Service, including, if known, the
Central Registry System suffix.
Item 7: ``Type of Applicant''--Self-explanatory.
Item 8: ``Type of Application''--Preprinted on the form.
Item 9: ``Name of Federal Agency''--Preprinted on the form.
Item 10: ``Catalog of Federal Domestic Assistance Number and
Title''--Enter the Catalog of Federal Domestic Assistance (CFDA) number
assigned to the program under which assistance is requested and its
title. The CFDA number for this program is 93.671.
Item 11: ``Descriptive Title of Applicant's Project''--Enter the
project title. The title is generally short and is descriptive of the
project.
Item 12: ``Areas Affected by Project''--Enter the governmental unit
where significant and meaningful impact could be observed. List only
the largest unit or units affected, such as State, county, or city. If
an entire unit is affected, list it rather than subunits.
Item 13: ``Proposed Project''--Enter the desired start date for the
project and projected completion date.
Item 14: ``Congressional District of Applicant/Project''--Enter the
number of the Congressional district where the applicant's principal
office is located and the number of the Congressional district(s) where
the project will be located. If statewide, a multi-State effort, or
nationwide, enter ``00.''
Items 15: ``Estimated Funding Levels''--
In completing 15a through 15f, the dollar amounts entered should
reflect, for a 17 month or less project period, the total amount
requested. If the proposed project period exceeds 17 months, enter only
those dollar amounts needed for the first 12 month budget period of the
proposed five year project period.
Item 15a: Enter the amount of Federal funds requested in accordance
with the preceding paragraph. This amount should be no greater than the
maximum amount specified in the project description.
Items 15b-e: Enter the amount(s) of funds from non-Federal sources
that will be contributed to the proposed project. Items b-e are
considered cost-sharing or ``matching funds.'' The value of third party
in-kind contributions should be included on appropriate lines as
applicable. For more information regarding funding and ``matching''
requirements, see Part I, Grantee Share of the Project.
Item 15f: Enter the estimated amount of income, if any, expected to
be generated from the proposed project. Do not add or subtract this
amount from the total project amount entered under item 15g. Describe
the nature, source and anticipated use of this income in the Project
Narrative Statement. If not applicable, enter N/A.
Item 15g: Enter the sum of items 15a-15e.
Item 16a: ``Is Application Subject to Review By State Executive
Order 12372 Process? Yes.''--Enter the date the applicant contacted the
SPOC regarding this application. Select the appropriate SPOC from the
listing provided at the end of Part IV. The review of the application
is at the discretion of the SPOC. The SPOC will verify the date noted
on the application. If there is a discrepancy in dates, the SPOC may
request that the Federal agency delay any proposed funding until
September 30, 1995.
Item 16b: ``Is Application Subject to Review By State Executive
Order 12372 Process? No.''--Check the appropriate box if the
application is not covered by E.O. 12372 or if the program has not been
selected by the State for review.
Item 17: ``Is the Applicant Delinquent on any Federal Debt?''--
Check the appropriate box. This question applies to the applicant
organization, not the person who signs as the authorized
representative. Categories of debt include audit disallowances, loans
and taxes.
Item 18: ``To the best of my knowledge and belief, all data in this
application/preapplication are true and correct. The document has been
duly authorized by the governing body of the applicant and the
applicant will comply with the attached assurances if the assistance is
awarded.''--To be signed by the authorized representative of the
applicant. A copy of the governing body's authorization for signature
of this [[Page 12226]] application by this individual as the official
representative must be on file in the applicant's office, and may be
requested from the applicant.
Item 18a-c: ``Typed Name of Authorized Representative, Title,
Telephone Number''--Enter the name, title and telephone number of the
authorized representative of the applicant organization.
Item 18d: ``Signature of Authorized Representative''--Signature of
the authorized representative named in Item 18a. At least one copy of
the application must have an original signature. Use colored ink (not
black) so that the original signature is easily identified.
Item 18e: ``Date Signed''--Enter the date the application was
signed by the authorized representative.
2. SF 424A--Budget Information--Non-Construction Programs
This is a form used by many Federal agencies. For this application,
Sections A, B, C, E and F are to be completed. Section D does not need
to be completed.
Sections A and B should include the Federal as well as the non-
Federal funding for the proposed project covering (1) The total project
period of 17 months or less; or (2) the first 12 month budget period,
if the proposed project period exceeds 17 months.
Section A--Budget Summary. This section includes a summary of the
budget. On line 5, enter total Federal costs in column (e) and total
non-Federal costs, including third party in-kind contributions, but not
program income, in column (f). Enter the total of (e) and (f) in column
(g).
Section B--Budget Categories. This budget, which includes the
Federal as well as non-Federal funding for the proposed project, covers
(1) The total project period of 17 months or less or (2) the first 12
month budget period if the proposed project period exceeds 17 months.
It should relate to item 15g, total funding, on the SF 424. Under
column (5), enter the total requirements for funds (Federal and non-
Federal) by object class category.
A separate budget justification should be included to explain fully
and justify major items, as indicated below. The types of information
to be included in the justification are indicated under each category.
For multiple year projects, it is desirable to provide this information
for each year of the project. The budget justification should
immediately follow the second page of the SF 424A.
Personnel--Line 6a. Enter the total costs of salaries and wages of
applicant/grantee staff. Do not include the costs of consultants, which
should be included on line 6h, ``Other.''
Justification: Identify the project director, if known. Specify by
title or name the percentage of time allocated to the project, the
individual annual salaries, and the cost to the project (both Federal
and non-Federal) of the organization's staff who will be working on the
project.
Fringe Benefits--Line 6b. Enter the total costs of fringe benefits,
unless treated as part of an approved indirect cost rate.
Justification: Provide a break-down of amounts and percentages that
comprise fringe benefit costs, such as health insurance, FICA,
retirement insurance, etc.
Travel--Line 6c. Enter total costs of out-of-town travel (travel
requiring per diem) for staff of the project. Do not enter costs for
consultant's travel or local transportation, which should be included
on Line 6h, ``Other.''
Justification: Include the name(s) of traveler(s), total number of
trips, destinations, length of stay, transportation costs and
subsistence allowances.
Equipment--Line 6d. Enter the total costs of all equipment to be
acquired by the project. For State and local governments, including
Federally recognized Indian Tribes, ``equipment'' is tangible, non-
expendable personal property having a useful life of more than one year
and an acquisition cost of $5,000 or more per unit. For all other
applicants, the threshold for equipment is $5,000 or more per unit. The
higher threshold for State and local governments became effective
October 1, 1988, through the implementation of 45 CFR Part 92,
``Uniform Administrative Requirements for Grants and Cooperative
Agreements to State and Local Governments.''
Justification: Equipment to be purchased with Federal funds must be
justified. The equipment must be required to conduct the project, and
the applicant organization or its subgrantees must not have the
equipment or a reasonable facsimile available to the project. The
justification also must contain plans for future use or disposal of the
equipment after the project ends.
Supplies--Line 6e. Enter the total costs of all tangible expendable
personal property (supplies) other than those included on Line 6d.
Justification: Specify general categories of supplies and their
costs.
Contractual--Line 6f: Enter the total costs of all contracts,
including procurement contracts (except those which belong on other
lines such as equipment, supplies, etc.) and contracts with secondary
recipient organizations. Also include any contracts with organizations
for the provision of technical assistance. Do not include payments to
individuals on this line.
Justification: Attach a list of contractors, indicating the names
of the organizations, the purposes of the contracts, and the estimated
dollar amounts of the awards as part of the budget justification.
Whenever the applicant/grantee intends to delegate part or all of the
program to another agency, the applicant/grantee must complete this
section (Section B, Budget Categories) for each delegate agency by
agency title, along with the supporting information. The total cost of
all such agencies will be part of the amount shown on Line 6f. Provide
backup documentation identifying the name of contractor, purpose of
contract, and major cost elements.
Construction--Line 6g: Not applicable. New construction is not
allowable.
Other--Line 6h: Enter the total of all other costs. Where
applicable, such costs may include, but are not limited to: Insurance;
medical and dental costs; noncontractual fees and travel paid directly
to individual consultants; local transportation (all travel which does
not require per diem is considered local travel); space and equipment
rentals; printing and publication; computer use; training costs,
including tuition and stipends; training service costs, including wage
payments to individuals and supportive service payments; and staff
development costs. Note that costs identified as ``miscellaneous'' and
``honoraria'' are not allowable.
Justification: Specify the costs included.
Total Direct Charges--Line 6i: Enter the total of Lines 6a through
6h.
Indirect Charges--6j: Enter the total amount of indirect charges
(costs). If no indirect costs are requested, enter ``none.'' Generally,
this line should be used when the applicant (except local governments)
has a current indirect cost rate agreement approved by the Department
of Health and Human Services or another Federal agency.
Local and State governments should enter the amount of indirect
costs determined in accordance with HHS requirements. When an indirect
cost rate is requested, these costs are included in the indirect cost
pool and should not be charged again as direct costs to the grant.
Justification: Enclose a copy of the indirect cost rate agreement.
Applicants subject to the limitation on the Federal reimbursement of
indirect costs for training grants should specify this. [[Page 12227]]
Total--Line 6k: Enter the total amounts of lines 6i and 6j.
Program Income--Line 7: Enter the estimated amount of income, if
any, expected to be generated from this project. Do not add or subtract
this amount from the total project amount.
Justification: Describe the nature, source, and anticipated use of
program income in the Program Narrative Statement.
Section C--Non-Federal Resources. This section summarizes the
amounts of non-Federal resources that will be applied to the grant.
Enter this information on line 12 entitled ``Totals.'' ``In-kind
contributions'' are defined in title 45 of the Code of Federal
Regulations, Part 74.2, as ``the value of non-cash contributions
provided by non-Federal third parties. Third party in-kind
contributions may be in the form of real, property, equipment, supplies
and other expandable property, and the value of goods and services
directly benefiting and specifically identifiable to the project or
program.''
Justification: Describe third party in-kind contributions, if
included.
Section D--Forecasted Cash Needs. Not applicable.
Section E--Budget Estimate of Federal Funds Needed for Balance of
the Project. This section should only be completed if the total project
period exceeds 17 months.
Totals--Line 20: For projects that will have more than one budget
period, enter the estimated required Federal funds for the second
budget period (months 13 through 24) under column ``(b) First.'' If a
third budget period will be necessary, enter the Federal funds needed
for months 25 through 36 under ``(c) Second.'' Columns (d) and (e) are
not applicable in most instances, since ACF funding is almost always
limited to a three-year maximum project period. They should remain
blank.
Section F--Other Budget Information.
Direct Charges--Line 21: Not applicable.
Indirect Charges--Line 22. Enter the type of indirect rate
(provisional, predetermined, final or fixed) that will be in effect
during the funding period, the estimated amount of the base to which
the rate is applied, and the total indirect expense.
Remarks--Line 23. If the total project period exceeds 17 months,
you must enter your proposed non-Federal share of the project budget
for each of the remaining years of the project.
3. Project Summary Description
Clearly mark this separate page with the applicant name as shown in
item 5 of the SF 424, and the title of the project as shown in item 11
of the SF 424. The summary description should not exceed 300 words.
These 300 words become part of the computer database on each project.
Care should be taken to produce a summary description which
accurately and concisely reflects the proposal. It should describe the
objectives of the project, the approaches to be used and the outcomes
expected. The description should also include a list of major products
that will result from the proposed project, such as software packages,
materials, management procedures, data collection instruments, training
packages, or videos (please note that audiovisuals should be closed
captioned). The project summary description, together with the
information on the SF 424, will constitute the project ``abstract.'' It
is the major source of information about the proposed project and is
usually the first part of the application that the reviewers read in
evaluating the application.
4. Program Narrative Statement
The Program Narrative Statement is a very important part of an
application. It should be clear, concise, and address the specific
requirements mentioned under the project description in Part II. The
narrative should also provide information concerning how the
application meets the evaluation criteria using the following headings:
(a) Need for the Project
(b) Goals and Objectives
(c) Approach
(d) Results and Benefits Expected
(e) Level of Effort
The specific information to be included under each of these headings is
described in Part III, Evaluation Criteria.
The narrative should be typed double-spaced on a single-side of an
8\1/2\'' x 11'' plain white paper, with 1'' margins on all sides. All
pages of the narrative (including charts, references/footnotes, tables,
maps, exhibits, etc.) must be sequentially numbered, beginning with
``Need for the Project'' as page number one. Applicants should not
submit reproductions of larger size paper, reduced to meet the size
requirement. There is no page limit on the length of the narrative.
The length of the remainder of the application, including the
application forms and all attachments, should not exceed 60 pages. A
page is a single side of an 8\1/2\'' x 11'' sheet of paper. Applicants
are requested not to send pamphlets, brochures or other printed
material along with their application as these pose photocopy
difficulties. These materials, if submitted, will not be included in
the review process if they exceed the 60-page limit. Each page of the
application will be counted to determine the total length.
5. Organizational Capability Statement
The Organizational Capability Statement should consist of a brief
(two to three pages) background description of how the applicant
organization (or the unit within the organization that will have
responsibility for the project) is organized, the types and quantity of
services it provides, and/or the research and management capabilities
it possesses. This description should cover capabilities not included
in the Program Narrative Statement. It may include descriptions of any
current or previous relevant experience, or describe the competence of
the project team and its demonstrated ability to produce a final
product that is readily comprehensible and usable. An organization
chart showing the relationship of the project to the current
organization should be included.
6. Assurances/Certifications
Applicants are required to file an SF 424B, Assurances-- Non-
Construction Programs, and the Certification Regarding Lobbying. Both
must be signed and returned with the application. In addition,
applicants must certify their compliance with: (1) Drug-Free Workplace
Requirements; and (2) Debarment and Other Responsibilities; and (3)
Certification Regarding Environmental Tobacco Smoke. These
certifications are self-explanatory. Copies of these assurances/
certifications are reprinted at the end of this announcement and should
be reproduced, as necessary. A duly authorized representative of the
applicant organization must certify that the applicant is in compliance
with these assurances/certifications. A signature on the SF 424
indicates compliance with the Drug Free Workplace Requirements, the
Debarment and Other Responsibilities, and the Environmental Tobacco
Smoke certifications.
D. Checklist for a Complete Application
The checklist below is for your use to ensure that your application
package has been properly prepared.
______One original, signed and dated application, plus two copies.
Applications for different priority areas are packaged separately;
______Application is from an organization which is eligible under the
eligibility requirements defined [[Page 12228]] in the priority area
description (screening requirement);
______Application length, excluding the narrative, does not exceed 60
pages, unless otherwise specified in the project description.
______A complete application consists of the following items in this
order:
______Application for Federal Assistance (SF 424, REV 4-88);
______A completed SPOC certification with the date of SPOC contact
entered in line 16, page 1 of the SF 424 if applicable.
______Budget Information--Non-Construction Programs (SF 424A, REV
4-88);
______Budget justification for Section B--Budget Categories;
______Table of Contents;
______Letter from the Internal Revenue Service to prove non-profit
status, if necessary;
______Copy of the applicant's approved indirect cost rate
agreement, if appropriate;
______Project summary description and listing of key words;
______Program Narrative Statement (See Part III);
______Organizational capability statement, including an
organization chart;
______Any appendices/attachments;
______Assurances--Non-Construction Programs (Standard Form 424B,
REV 4-88); and
______Certification Regarding Lobbying.
E. The Application Package
Each application package must include an original and two copies of
the complete application. Each copy should be stapled securely (front
and back if necessary) in the upper left-hand corner. All pages of the
narrative (including charts, tables, maps, exhibits, etc.) must be
sequentially numbered, beginning with page one. In order to facilitate
handling, please do not use covers, binders or tabs. Do not include
extraneous materials as attachments, such as agency promotion
brochures, slides, tapes, film clips, minutes of meetings, survey
instruments or articles of incorporation.
Applicant should include a self-addressed, stamped acknowledgment
card. All applicants will be notified automatically about the receipt
of their application. If acknowledgment of receipt of your application
is not received within eight weeks after the deadline date, please
notify ACF by telephone at (202) 401-5529.
(Catalog of Federal Domestic Assistance Number 93.671, Family
Violence Prevention and Services.)
Dated: March 1, 1995.
Donald Sykes,
Director, Office of Community Services.
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BILLING CODE 4184-01-C
[[Page 12230]]
Instructions for the SF 424
This is a standard form used by applicants as a required
facesheet for preapplications and applications submitted for Federal
assistance. It will be used by Federal agencies to obtain applicant
certification that States which have established a review and
comment procedure in response to Executive Order 12372 and have
selected the program to be included in their process, have been
given an opportunity to review the applicant's submission.
Item and Entry
1. Self-explanatory.
2. Date application submitted to Federal agency (or State if
applicable) & applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing
award, enter present Federal identifier number. If for a new
project, leave blank.
5. Legal name of applicant, name of primary organizational unit
which will undertake the assistance activity, complete address of
the applicant, and name and telephone number of the person to
contact on matters related to this application.
6. Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
--``New'' means a new assistance award.
--``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
--``Revision'' means any change in the Federal Government's
financial obligation or contingent liability from an existing
obligation.
9. Name a Federal agency from which assistance is being
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number and
title of the program under which assistance is requested.
11. Enter a brief descriptive title of the project. If more than
one program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real property
projects), attach a map showing project location. For
preapplications, use a separate sheet to provide a summary
description of this project.
12. List only the largest political entities affected (e.g.,
State, counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and any
District(s) affected by the program or project.
15. Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as applicable.
If the action will result in a dollar change to an existing award,
indicate only the amount of the change. For decreases, enclose the
amounts in parentheses. If both basic and supplemental amounts are
included, show breakdown on an attached sheet. For multiple program
funding, use totals and show breakdown using same categories as item
15.
16. Applicants should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine whether the
application is subject to he State intergovernmental review process.
17. This question applies to the applicant organization, not the
person who signs as the authorized representative. Categories of
debt include delinquent audit disallowances, loans and taxes.
18. To be signed by the authorized representative of the
applicant. A copy of the governing body's authorization for you to
sign this application as official representative must be on file in
the applicant's office. (Certain federal agencies may require that
this authorization be submitted as part of the application.)
BILLING CODE 4184-01-M
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BILLING CODE 4184-01-C
[[Page 12233]]
Instructions for the SF-424A
General Instructions
This form is designed so that application can be made for funds
from one or more grant programs. In preparing the budget, adhere to
any existing Federal grantor agency guidelines which prescribe how
and whether budgeted amounts should be separately shown for
different functions or activities within the program. For some
programs, grantor agencies may require budgets to be separately
shown by function or activity. For other programs, grantor agencies
may require a breakdown by function or activity. Sections A, B, C,
and D should include budget estimates for the whole project except
when applying for assistance which requires Federal authorization in
annual or other funding period increments. In the latter case,
Sections A, B, C, and D should provide the budget for the first
budget period (usually a year) and Section E should present the need
for Federal assistance in the subsequent budget periods. All
applications should contain a breakdown by the object class
categories shown in Lines a-k of Section B.
Section A. Budget Summary
Lines 1-4, Columns (a) and (b)
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring a
functional or activity breakdown, enter on Line 1 under Column (a)
the catalog program title and the catalog number in Column (b).
For applications pertaining to a single program requiring budget
amounts by multiple functions or activities, enter the name of each
activity or function on each line in Column (a), and enter the
catalog number in Column (b). For applications pertaining to
multiple programs where none of the programs require a breakdown by
function or activity, enter the catalog program title on each line
in Column (a) and the respective catalog number on each line in
Column (b).
For applications pertaining to multiple programs where one or
more programs require a breakdown by function or activity, prepare a
separate sheet for each program requiring the breakdown. Additional
sheets should be used when one form does not provide adequate space
for all breakdown of data required. However, when more than one
sheet is used, the first page should provide the summary totals by
programs.
Lines 1-4, Columns (c) Through (g.)
For new applications, leave Columns (c) and (d) blank. For each
line entry in Columns (a) and (b), enter in Columns (e), (f), and
(g) the appropriate amounts of funds needed to support the project
for the first funding period (usually a year).
For continuing grant program applications, submit these forms
before the end of each funding period as required by the grantor
agency. Enter in Columns (c) and (d) the estimated amounts of funds
which will remain unobligated at the end of the grant funding period
only if the Federal grantor agency instructions provide for this.
Otherwise, leave these columns blank. Enter in columns (e) and (f)
the amounts of funds needed for the upcoming period. The amount(s)
in Column (g) should be the sum of amounts in Columns (e) and (f).
For supplemental grants and changes to existing grants, do not
use Columns (c) and (d). Enter in Column (e) the amount of the
increase or decrease of Federal funds and enter in Column (f) the
amount of the increase or decrease of non-Federal funds. In Column
(g) enter the new total budgeted amount (Federal and non-Federal)
which includes the total previous authorized budgeted amounts plus
or minus, as appropriate, the amounts shown in Columns (e) and (f).
The amount(s) in Column (g) should not equal the sum of amounts in
Columns (e) and (f).
Line 5--Show the totals for all columns used.
Section B. Budget Categories
In the column headings (1) through (4), enter the titles of the
same programs, functions, and activities shown on Lines 1-4, Column
(a), Section A. When additional sheets are prepared for Section A,
provide similar column headings on each sheet. For each program,
function or activity, fill in the total requirements for funds (both
Federal and non-Federal) by object class categories.
Lines 6a-i--Show the totals of Lines 6a to 6h in each column.
Line 6j--Show the amount of indirect cost.
Line 6k--Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total amount
in column (5), Line 6k, should be the same as the total amount shown
in Section A, Column (g), Line 5. For supplemental grants and
changes to grants, the total amount of the increase or decrease as
shown in Columns (1)-(4). Line 6k should be the same as the sum of
the amounts in Section A, Columns (e) and (f) on Line 5.
Line 7--Enter the estimated amount of income, if any, expected
to be generated form this project. Do not add or subtract this
amount from the total project amount. Show under the program
narrative statement the nature and source of income. The estimated
amount of program income may be considered by the federal grantor
agency in determining the total amount of the grant.
Section C. Non-Federal-Resources
Lines 8-11--Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.
Column (a)--Enter the program titles identical to Column (a),
Section A. A breakdown by function or activity is not necessary.
Column (b)--Enter the contribution to be made by the applicant.
Column (c)--Enter the amount of the State's cash and in-kind
contribution if the applicant is not a State or State agency.
Applicants which are a State or State agencies should leave this
column blank.
Column (d)--Enter the amount of cash and in-kind contributions
to be made from all other sources.
Column (e)--Enter totals of Columns (b), (c), and (d).
Line 12--Enter the total for each of Columns (b)-(e). The amount
in Column (e) should be equal to the amount on Line 5, Column (f),
Section A.
Section D. Forecasted Cash Needs
Line 13--Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14--Enter the amount of cash from all other sources needed
by quarter during the first year.
Line 15.--Enter the totals of amounts on Lines 13 and 14.
Section E. Budget Estimates of Federal Funds Needed for Balance of
the Project
Lines 16-19--Enter in Column (a) the same grant program titles
shown in column (a), Section A. A breakdown by function or activity
is not necessary. For new applications and continuation grant
applications, enter in the proper columns amounts of Federal funds
which will be needed to complete the program or project over the
succeeding funding periods (usually in years). This section need not
be completed for revisions (amendments, changes, or supplements) to
funds for the current year of existing grants.
If more than four lines are needed to list the program titles,
submit additional schedules as necessary.
Line 20--Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21--Use this space to explain amounts for individual direct
object-class cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal
grantor agency.
Line 22--Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during the
funding period, the estimated amount of the base to which the rate
is applied, and the total indirect expense.
Line 23--Provide any other explanations or comments deemed
necessary.
Assurances--Non-Construction Programs
Note: Certain of these assurances may not be applicable to your
project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may
require applicants to certify to additional assurances. If such is
the case, you will be notified.
As the duly authorized representative of the applicant I certify
that the applicant:
1. Has the legal authority to apply for Federal assistance, and
the institutional, managerial and financial capability (including
funds sufficient to pay the non-Federal share of project costs) to
ensure proper planning, management and completion of the project
described in this application.
2. Will give the awarding agency, the Comptroller General of the
United States, and if appropriate, the State, through any authorized
representative, access to and the [[Page 12234]] right to examine
all records, books, papers, or documents related to the award; and
will establish a proper accounting system in accordance with
generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using
their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or
personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970
(42 U.S.C. Secs. 4728-4763) relating to prescribed standards for
merit systems for programs funded under one of the nineteen statutes
or regulations specified in Appendix A of OPM's Standards for a
Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to: (a) Title
VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b)
Title IX of the Education Amendments of 1972, as amended (20 U.S.C.
Secs. 1681-1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973,
as amended (29 U.S.C. Sec. 794), which prohibits discrimination on
the basis of handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. Secs. 6101-6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and Treatment Act of
1972 (P.L. 92-255), as amended, relating to nondiscrimination on the
basis of drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation Act of 1970
(P.L. 91-616), as amended, relating to nondiscrimination on the
basis of alcohol abuse or alcoholism; (g) Secs. 523 and 527 of the
Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3),
as amended, relating to confidentiality of alcohol and drug abuse
patient records; (h) Title VIII of the Civil Rights Act of 1968 (42
U.S.C. Sec. 3601 et seq.), as amended, relating to nondiscrimination
in the sale, rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s) under which
application for Federal assistance is being made; and (j) the
requirements of any other nondiscrimination statute(s) which may
apply to the application.
7. Will comply, or has already complied, with the requirements
of Titles II and III of the Uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L. 91-646) which
provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or federally
assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of Federal
participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C.
Secs. 1501-1508 and 7324-7328) which limit the political activities
of employees whose principal employment activities are funded in
whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40
U.S.C. Sec. 276c and 18 U.S.C. Sec. 874), and the Contract Work
Hours and Safety Standards Act (40 U.S.C. Secs. 327-333), regarding
labor standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster Protection Act
of 1973 (P.L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase flood
insurance if the total cost of insurable construction and
acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order
(EO) 11514; (b) notification of violating facilities pursuant to EO
11738; (c) protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance with EO
11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. Sec. 1451 et seq.); (f) conformity of Federal
actions to State (Clear Air) Implementation Plans under Section
176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. Sec. 7401
et seq.); (g) protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523); and (h) protection of endangered species under the Endangered
Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16
U.S.C. Sec. 1271 et seq.) related to protecting components or
potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with
Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470), EO 11593 (identification and protection of
historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966
(P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the
care, handling, and treatment of warm blooded animals held for
research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention
Act (42 U.S.C. Sec. 4801 et seq.) which prohibits the use of lead
based paint in construction or rehabilitation of residence
structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations and policies governing
this program.
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Signature of authorized certifying official
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Title
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Applicant organization
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Date submitted
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Certification Regarding Debarment, Suspension, and Other
Responsibility Matters--Primary Covered Transactions
By signing and submitting this proposal, the applicant, defined
as the primary participant in accordance with 45 CFR Part 76,
certifies to the best of its knowledge and believe that it and its
principals:
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from covered
transactions by any Federal Department or agency;
(b) have not within a 3-year period preceding this proposal been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (Federal,
State, or local) transaction or contract under a public transaction;
violation of Federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, or receiving stolen property;
(c) are not presently indicted or otherwise criminally or
civilly charged by a governmental entity (Federal, State or local)
with commission of any of the offenses enumerated in paragraph
(1)(b) of this certification; and
(d) have not within a 3-year period preceding this application/
proposal had one or more public transactions (Federal, State, or
local) terminated for cause or default.
The inability of a person to provide the certification required
above will not necessarily result in denial of participation in this
covered transaction. If necessary, the prospective participant shall
submit an explanation of why it cannot provide the certification.
The certification or explanation will be considered in connection
with the Department of Health and Human Services (HHS) determination
whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an
explanation shall disqualify such person from participation in this
transaction.
The prospective primary participant agrees that by submitting
this proposal, it will include the clause entitled ``Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion--Lower Tier Covered Transaction.'' provided below without
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion--Lower Tier Covered Transactions
(To Be Supplied to Lower Tier Participants)
By signing and submitting this lower tier proposal, the
prospective lower tier participant, as defined in 45 CFR Part 76,
certifies to the best of its knowledge and belief that it and its
principals:
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by federal department or agency.
(b) where the prospective lower tier participant is unable to
certify to any of the above, such prospective participant shall
attach an explanation to this proposal.
The prospective lower tier participant further agrees by
submitting this proposal that it will include this clause entitled
``certification Regarding Debarment, Suspension, Ineligibility, and
Voluntary Exclusion--Lower Tier Covered Transactions.'' without
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
Attachment D--Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative
Agreements
The undersigned certifies, to the best of his or her knowledge
and belief, that:
(1) No Federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification
of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant,
loan or cooperative agreement, the undersigned shall complete and
submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in
accordance with its instructions.
(3) The undersigned shall require that the language of this
certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
State for Loan Guarantee and Loan Insurance
The undersigned states, to the best of his or her knowledge and
belief, that:
If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with this
commitment providing for the United States to insure or guarantee a
loan, the undersigned shall complete and submit Standard Form-LLL
``Disclosure Form to Report Lobbying,'' in accordance with its
instructions.
Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required statement shall
be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
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Signature
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Title
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Organization
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Date
BILLING CODE 4184-01-M
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BILLING CODE 4184-01-C
[[Page 12239]]
Attachment E
Executive Order 12372--State Single Points of Contact
Arizona
Mrs. Janice Dunn, Attn: Arizona State Clearinghouse, 3800 N. Central
Avenue, 14th Floor, Phoenix, Arizona 85012, Telephone (602) 280-1315
Arkansas
Tracie L. Copeland, Manager, State Clearinghouse, Office of
Intergovernmental Services, Department of Finance and
Administration, P.O. Box 3278, Little Rock, Arkansas 72203,
Telephone (501) 682-1074
California
Glenn Stober, Grants Coordinator, Office of Planning and Research,
1400 Tenth Street, Sacramento, California 95814, Telephone (916)
323-7480
Delaware
Ms. Francine Booth, State Single Point of Contact, Executive
Department, Thomas Collins Building, Dover, Delaware 19903,
Telephone (303) 736-3326
District of Columbia
Rodney T. Hallman, State Single Point of Contact, Office of Grants
Management and Development, 717 14th Street, NW., Suite 500,
Washington, DC. 20005, Telephone (202) 727-6551
Florida
Florida State Clearinghouse, Intergovernmental Affairs Policy Unit,
Executive Office of the Governor, Office of Planning and Budgeting,
The Capitol, Tallahassee, Florida 32399-0001, Telephone (904) 488-
8441
Georgia
Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse,
254 Washington Street, SW., Atlanta, Georgia 30334, Telephone (404)
656-3855
Illinois
Steve Klokkenga, State Single Point of Contact, Office of the
Governor, 107 Stratton Building, Springfield, Illinois 62706,
Telephone (217) 782-1671
Indiana
Jean S. Blackwell, Budget Director, State Budget Agency, 212 State
House, Indianapolis, Indiana 46204, Telephone (317) 232-5610
Iowa
Mr. Steven R. McCann, Division of Community Progress, Iowa
Department of Economic Development, 200 East Grand Avenue, Des
Moines, Iowa 50309, Telephone (515) 281-3725
Kentucky
Ronald W. Cook, Office of the Governor, Department of Local
Government, 1024 Capitol Center Drive, Frankfort, Kentucky 40601,
Telephone (502) 564-2382
Maine
Ms. Joyce Bension, State Planning Office, State House Station #38,
Augusta, Maine 04333, Telephone (207) 289-3261
Maryland
Ms. Mary Abrams, Chief, Maryland State Clearinghouse, Department of
State Planning, 301 West Preston Street, Baltimore, Maryland 21201-
2365, Telephone (301) 225-4490
Massachusetts
Karen Arone, State Clearinghouse, Executive Office of Communities
and Development, 100 Cambridge Street, Room 1803, Boston,
Massachusetts 02202, Telephone (617) 727-7001
Michigan
Richard S. Pastula, Director, Michigan Department of Commerce,
Lansing, Michigan 48909, Telephone (517) 373-7356
Mississippi
Ms. Cathy Mallette, Clearinghouse Officer, Office of Federal Grant
Management and Reporting, 301 West Pearl Street, Jackson,
Mississippi 39203, Telephone (601) 960-2174
Missouri
Ms. Lois Pohl, Federal Assistance Clearinghouse, Office of
Administration, P.O. Box 809, Room 430, Truman Building, Jefferson
City, Missouri 65102, Telephone (314) 751-4834
Nevada
Department of Administration, State Clearinghouse, Capitol Complex,
Carson City, Nevada 89710, Telephone (702) 687-4065, Attention: Ron
Sparks, Clearinghouse Coordinator
New Hampshire
Mr. Jeffrey H. Taylor, Director, New Hampshire Office of State
Planning, Attn: Intergovernmental Review, Process/James E. Bieber,
2\1/2\ Beacon Street, Concord, New Hampshire 03301, Telephone (603)
271-2155
New Jersey
Gregory W. Adkins, Acting Director, Division of Community Resources,
N.J. Department of Community Affairs, Trenton, New Jersey 08625-
0803, Telephone (609) 292-6613
Please direct correspondence and questions to:
Andrew J. Jaskolka, State Review Process, Division of Community
Resources, CN 814, Room 609, Trenton, New Jersey 08625-0803,
Telephone (609) 292-9025
New Mexico
George Elliott, Deputy Director, State Budget Division, Room 190,
Bataan Memorial Building, Santa Fe, New Mexico 87503, Telephone
(505) 827-3640, Fax (505) 827-3006
New York
New York State Clearinghouse, Division of the Budget, State Capitol,
Albany, New York 12224, Telephone (518) 474-1605
North Carolina
Mrs. Chrys Baggett, Director, Office of the Secretary of Admin.,
N.C. State Clearinghouse, 116 W. Jones Street, Raleigh, North
Carolina 27603-8003, Telephone (919) 733-7232
North Dakota
N.D. Single Point of Contact, Office of Intergovernmental
Assistance, Office of Management and Budget, 600 East Boulevard
Avenue, Bismarck, North Dakota 58505-0170, Telephone (701) 224-2094
Ohio
Larry Weaver, State Single Point of Contact, State/Federal Funds
Coordinator, State Clearinghouse, Office of Budget and Management,
30 East Broad Street, 34th Floor, Columbus, Ohio 43266-0411,
Telephone (614) 466-0698
Rhode Island
Mr. Daniel W. Varin, Associate Director, Statewide Planning Program,
Department of Administration, Division of Planning, 265 Melrose
Street, Providence, Rhode Island 02907, Telephone (401) 277-2656
Please direct correspondence and questions to:
Review Coordinator, Office of Strategic Planning
South Carolina
Omeagia Burgess, State Single Point of Contact, Grant Services,
Office of the Governor, 1205 Pendleton Street, Room 477, Columbia,
South Carolina 29201, Telephone (803) 734-0494
Tennessee
Mr. Charles Brown, State Single Point of Contact, State Planning
Office, 500 Charlotte Avenue, 309 John Sevier Building, Nashville,
Tennessee 37219, Telephone (615) 741-1676
Texas
Mr. Thomas Adams, Governor's Office of Budget and Planning, P.O. Box
12428, Austin, Texas 78711, Telephone (512) 463-1778
Utah
Utah State Clearinghouse, Office of Planning and Budget, ATTN:
Carolyn Wright, Room 116 State Capitol, Salt Lake City, Utah 84114,
Telephone (801) 538-1535
Vermont
Mr. Bernard D. Johnson, Assistant Director, Office of Policy
Research and Coordination, Pavilion Office Building, 109 State
Street, Montpelier, Vermont 05602, Telephone (802) 828-3326
West Virginia
Mr. Fred Cutlip, Director, Community Development Division, West
Virginia Development Office, Building #6, Room 553, Charleston, West
Virginia 25305, Telephone (304) 348-4010
Wisconsin
Mr. William C. Carey, Federal/State Relations, Wisconsin Department
of Administration, 101 South Webster Street, P.O. Box 7864, Madison,
Wisconsin 53707, Telephone (608) 266-0267
Wyoming
Sheryl Jeffries, State Single Point of Contact, Herschler Building,
4th Floor, East Wing, Cheyenne, Wyoming 82002, Telephone (307) 777-
7574
[[Page 12240]]
Guam
Mr. Michael J. Reidy, Director, Bureau of Budget and Management
Research, Office of the Governor, P.O. Box 2950, Agana, Guam 96910,
Telephone (671) 472-2285
Northern Mariana Islands
State Single Point of Contact, Planning and Budget Office, Office of
the Governor, Saipan, CM, Northern Mariana Islands 96950
Puerto Rico
Norma Burgos/Jose H. Caro, Chairman/Director, Puerto Rico Planning
Board, Minillas Government Center, P.O. Box 41119, San Juan, Puerto
Rico 00940-9985, Telephone (809) 727-4444
Virgin Islands
Jose L. George, Director, Office of Management and Budget, #41
Norregade Emancipation Garden Station, Second Floor, Saint Thomas,
Virgin Islands 00802
Please direct correspondence to:
Linda Clarke, Telephone (809) 774-0750
Attachment F
Certification Regarding Environmental Tobacco Smoke
Public Law 103-227, Part C--Environmental Tobacco Smoke, also
known as the Pro-Children Act of 1994 (Act), requires that smoking
not be permitted in any portion of any indoor facility owned or
leased or contracted for by an entity and used routinely or
regularly for the provision of health, day care, education, or
library services to children under the age of 18, if the services
are funded by Federal programs either directly or through State or
local governments, by Federal grant, contract, loan, or loan
guarantee. The law does not apply to children's services provided in
private residences, facilities funded solely by Medicare or Medicaid
funds, and portions of facilities used for inpatient drug or alcohol
treatment. Failure to comply with the provisions of the law may
result in the imposition of a civil monetary penalty of up to $1000
per day and/or the imposition of an administrative compliance order
on the responsible entity.
By signing and submitting this application the applicant/grantee
certifies that it will comply with the requirements of the Act. The
applicant/grantee further agrees that it will require the language
of this certification be included in any subawards which contain
provisions for children's services and that all subgrantees shall
certify accordingly.
[FR Doc. 95-5409 Filed 3-3-95; 8:45 am]
BILLING CODE 4184-01-P