[Federal Register Volume 60, Number 64 (Tuesday, April 4, 1995)]
[Notices]
[Pages 17066-17084]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-8131]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
Responsible Fatherhood Projects
AGENCY: Administration for Children and Families, (ACF), Department of
Health and Human Services, (HHS).
[[Page 17067]] ACTION: Announcement of the availability of funds and
request for applications to demonstrate promising program interventions
to encourage and increase responsible fatherhood.
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SUMMARY: The Administration for Children and Families (ACF) announces
the availability of Federal funding to demonstrate promising program
interventions to encourage and increase responsible fatherhood. Funding
under this announcement is authorized by section 1110 of the Social
Security Act governing Social Services Research and Demonstration
activities (Catalog of Federal Domestic Assistance 93.647).
DATES: The closing date for submission of applications is June 5, 1995.
MAILING ADDRESSES: William J. McCarron, Administration for Children and
Families, Division of Discretionary Grants--Room 6C-462, 370 L'Enfant
Promenade SW., Washington, DC 20447. For hand delivered applications,
use: William J. McCarron, Administration for Children and Families,
Division of Discretionary Grants, 6th Floor, ACF Guard Station, 901 D
Street SW., Washington, DC 20447.
FOR FURTHER INFORMATION CONTACT: Mark Fucello, Administration for
Children and Families, Office of Policy and Evaluation, 370 L'Enfant
Promenade SW., Washington, DC 20447. Telephone (202) 401-4538.
SUPPLEMENTARY INFORMATION: The Administration for Children and Families
announces that competing applications are being accepted for Federal
financial assistance to demonstrate promising program interventions to
encourage and increase responsible fatherhood. Up to five awards will
be made under this announcement for project periods of 24 months. Each
successful recipient will receive a financial award for an initial
budget period of 17 months. The second budget period, consisting of
months 18 through 24, will be unfunded with Federal funds; applicants
are encouraged to secure other sources of funding to cover these latter
months of the project period. Each recipient will be expected to enter
into a cooperative agreement with ACF which will outline the terms of
ACF's interest and involvement in the project and the responsibilities
of the recipient.
This program announcement consists of three parts. Part I describes
the activities supported by this announcement and application
requirements. Part II describes the application review process. Part
III provides information and instructions for the development and
submission of applications. The forms to be used for submitting an
application follow Part III.
Part I.--Project Design
Purpose
The purpose of the announcement is to inform the public of the
availability of Federal funding to demonstrate promising program
interventions to encourage and increase responsible fatherhood. There
is a growing body of evidence suggesting that the impact of fathers'
participation on children's behavior is significant. Although research
does not suggest a straightforward relationship between paternal
participation in child rearing and child well-being, it can be
reasonably assumed that children benefit emotionally and
developmentally when fathers play a larger role in children's lives.
According to this program announcement, ACF will provide funding to
community programs designed to strengthen the role and parenting
abilities of fathers and to enable fathers to relate positively to
their children and their children's mothers. The target populations for
these programs should encompass a wide range of fathers including
disadvantaged, never-married non-custodial fathers; separated or
divorced non-custodial fathers, as well as fathers living with their
children.
The recipients will operate projects designed to create an
environment where fathers are encouraged and supported in conduct that
allows them to improve the quality of life for their families. Projects
should provide comprehensive services designed to assist men and their
families for the purpose of attempting to reverse the negative trends
among adults and youth related to at-risk behaviors such as substance
abuse, gang involvement, school failure, and unemployment. Beyond
encouraging and increasing basic responsible acts such as establishing
paternity and encouraging contact between father and children, programs
should teach fathers:
How to understand their children's development,
How to understand and positively affect their children's
behavior,
How to be positive role models for their children, and
How to work constructively with the children's mother for
the benefit of the children regardless of whether both parents live in
the same household as the children.
Eligible Applicants
Organizations eligible to apply for financial assistance under this
announcement include States, local governments, and public or private
nonprofit organizations. Any nonprofit organization submitting an
application must submit proof of its nonprofit status in its
application at the time of submission. The nonprofit 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.
ACF is interested in providing financial support to organizations:
With experience in working with fathers and which are knowledgeable
about the issues concerning fathers; with developed plans and methods
to teach fathers how to act responsibly and to understand their
children's development and positively affect their children's behavior;
and which have significant, long-term financial support ensuring
uninterrupted project operation beyond the projected period of federal
assistance.
Minimum Requirements for Project Design
In order to compete successfully in response to this announcement,
the applicant should develop an application which:
Describes the applicant's experience in working with
fathers. The description should highlight the applicant's experience in
coordinating services from different providers or levels of government
aimed at encouraging men to be responsible fathers and should describe
the men whom the project has served. The types of services provided or
to which clients are referred may include health and nutrition
instruction, employment and career counseling, parenting education,
peer support, and formal and informal mediation and dispute resolution
with the children's mother, etc.
Explains the applicant's methods to teach fathers how to
act responsibly and to adopt behaviors which exemplify the following
principles: Raising children requires an active commitment from both
parents--financially and emotionally; employment is important to being
a responsible father not only to provide financial support but also to
be a good role model; and successful child-rearing depends on
understanding how children develop. The application must explain in
detail how the proposed project aims to enable fathers at risk of
[[Page 17068]] destructive behaviors to develop an achievement
orientation from which they will be better able to act responsibly and
to interact constructively with the children and the children's mother
regardless of whether both parents live in the same household as the
children.
Identifies the typical settings or points in fathers'
lives that the applicant first engages and enrolls individuals for
program services, e.g., in-hospital recruitment of new fathers,
community centers where neighborhood men gather, half-way houses, etc.
ACF is interested in funding a group of programs which together engage
men at various points in their lives and in various settings to help
develop for the public a better understanding about how to structure
programs and services for fathers.
Includes assurance that the recipient will produce two
major reports (in addition to regular quarterly progress reports) to be
issued during the project. The initial major report, due mid-way into
the project, should discuss program implementation and participation
and activities of fathers, including a discussion of program approaches
and activities, paternity establishment, level of employment among
participating fathers, and level of contact of fathers with their
children as well as with the children's mother. The final report, due
at the end of the project (90 days after the end of the 24-month
project period), should cover the topics discussed above with longer
follow-up and more detailed discussion of the project's staffing
structure; procedures for referrals to services and coordination with
other public and private agencies; type and duration of services
actually provided; procedures and criteria used in recruitment and
training of staff; and recommendations for others seeking to establish
similar projects. Recommendations should include a discussion of the
project's contextual factors, such as the social, economic, and
political forces that may have a bearing on the implementation of this
type of project. These reports are intended to further the general
knowledge of the public, community-based organizations, and social
service departments regarding program interventions to increase
responsible fatherhood. In addition regular quarterly progress reports
must be submitted within 60 days of the end of each quarter of the 24-
month project period.
Includes assurance of the recipient's willingness and
intention to participate in and cooperate with evaluability assessment
activities to be funded by the Department of Health and Human Services,
possibly leading to a full-scale program evaluation if determined to be
feasible.
Includes financial support for project activities in
addition to Federal funding to ensure uninterrupted project operation
over the project period. ACF will give preference to applicants who
provide evidence of significant, long-term financial support ensuring
uninterrupted project operation beyond the period of federal
assistance. Applicants should provide evidence of funding commitments
from organizations such as private foundations.
Also, the recipient must be prepared to enter into a cooperative
agreement with ACF which will outline the terms of ACF's interest and
involvement in the project and the responsibilities of the recipient.
The cooperative agreement:
(a) Will provide that ACF retain authority for review of
significant program design changes from the model proposed in the
original application; (b) will provide that ACF maintain involvement in
any evaluability assessment activities to be funded by the Department
of Health and Human Services, and (c) will provide for ACF review of
reports (other than quarterly progress reports) before publication.
Project Duration
This announcement is soliciting applications for project periods of
24 months. Awards, on a competitive basis, will be for an initial 17-
month budget period, although project periods will be for 24 months,
subject to availability of funds. Each recipient will receive an
initial financial award for 17 months. The second budget period,
consisting of months 18 through 24, will be unfunded with Federal
funds; applicants are encouraged to secure other sources of funding to
cover these latter months of the project period.
Federal Share of the Project
The maximum Federal share of each project is not to exceed $85,000
for the initial 17-month budget period, subject to the availability of
funds.
Matching Requirement
Recipients must provide at least 20 percent of the total approved
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 in-kind contributions from a third party or cash, although
applicants are encouraged to meet their match requirements through cash
contributions. Therefore, a project requesting $85,000 in Federal funds
must include a match of at least $21,250 (20 percent of total project
cost).
If approved for funding, recipients will be held accountable for
commitments of non-Federal resources; and failure to provide the
required amount will result in a disallowance of unmatched Federal
funds.
Anticipated number of Projects to be Funded
Five projects will be funded under this announcement. A single
organization may apply on behalf of separate project sites operated by
the same organization. If operated by the same organization, each
project site which applies must submit a separate application.
Part II--The Review Process
A. Review Process and Funding Decisions
Timely applications from eligible applicants will be reviewed and
scored competitively. Reviewers will use the evaluation criteria listed
below to review and score the application.
In addition ACF may refer applications for review to other Federal
or non-Federal entities when it is determined to be in the best
interest of the Federal Government or the applicant. It may also
solicit comments from ACF Regional Office staff, other Federal
agencies, interested foundations and national organizations. These
comments along with those of the reviewers will be considered by ACF in
making the funding decision.
In making a funding decision, ACF may give preference to
applications which reflect experience in working with fathers since
such experience on the part of an applicant has the potential to
substantially improve the theory and practice of increasing responsible
behavior among fathers and improving the well-being of their children.
ACF may also give preference to applicants who make a greater
financial commitment to the demonstration since a greater total
financial investment than the minimum required in this announcement has
the potential of producing a high benefit in furthering knowledge about
policies and practice of working with fathers for a low Federal
investment.
B. Evaluation Criteria
Using the evaluation criteria below, reviewers will review and
score each application. Applicants should insure that they address each
minimum requirement listed above.
Reviewers will determine the strengths and weaknesses of each
[[Page 17069]] application in terms of the appropriate evaluation
criteria listed below, provide comments, and assign numerical scores.
The point value following each criterion heading indicates the maximum
numerical weight that each criterion may be given in the review
process.
Review Criteria
(1) Organizational experience (15 points) The application should
provide evidence of organizational experience in working with fathers
including disadvantaged, never-married non-custodial fathers; separated
or divorced non-custodial fathers, as well as fathers living with their
children. Evidence of this experience should include a complete
description of past or current projects which serve fathers and are
aimed at improving their understanding of their responsibilities to
their children, their roles as fathers, and their children's
development.
(2) Staff skills and responsibilities (15 points) The application
should list each consultant or other key individuals who will work on
the project along with a short description of the nature of their
contribution. Summarize the background and experience of the project
director and key project staff. Applicants are encouraged to discuss
staff experience in working with fathers.
(3) Knowledge of issues concerning fathers (15 points) The
application should provide evidence of the applicant's understanding of
the demographics and experiences of fathers, including disadvantaged,
never-married non-custodial fathers; separated or divorced non-
custodial fathers, as well as fathers living with their children.
Evidence of this understanding should include (a) knowledge of key
issues concerning fathers, any obstacles to effecting healthy levels of
paternal involvement in their children's lives, and strengths and
deficits of fathers in meeting their responsibilities to their
children; and (b) if appropriate to the target population of fathers
considered, familiarity with how men interact with child support
enforcement systems, courts, employment and training programs, and
social service agencies.
(4) Approach and project design (50 points) The application should
describe how the organization will operate projects designed to create
an environment where fathers are encouraged and supported in conduct
that allows them to improve the quality of life for their families. The
application should explain the applicant's methods to teach fathers how
to act responsibly and to adopt behaviors which exemplify the following
principles: Raising children requires an active commitment from both
parents--financially and emotionally; employment is important to being
a responsible father not only to provide financial support but also to
be a good role model; and successful child-rearing depends on
understanding how children develop. The application must explain in
detail the typical settings or points in fathers' lives that the
applicant first plans to engage and enroll individuals for program
services, e.g., in-hospital, community centers, employment agency, etc.
The application should explain how the project plans to increase basic
responsible acts among fathers, such as establishing paternity and
encouraging contact between father and children, but also, and more
important, how programs will teach fathers to understand their
children's development, to understand and positively affect their
children's behavior, to be positive role models for their children, and
to work constructively with the children and the children's mother
regardless of whether both parents live in the same household as the
children. The application should also describe the types of services to
be provided or to which clients will be referred, e.g., health and
nutrition instruction, employment and career counseling, parenting
education, peer support, formal and informal mediation and dispute
resolution with the children's mother, etc.
(5) Budget Appropriateness (5 points) The application should
demonstrate that the project's costs are reasonable in view of the
anticipated results and benefits. Applicants may refer to the budget
information presented in the Standard Forms 424 and 424A.
Part III. 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 announcement along with a checklist for
assembling an application package.
A. Required Notification of the State Single Point of Contact
This program announcement 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
Program and Activities.'' Under the Order, States may design their own
processes for reviewing and commenting on proposed Federal assistance
under covered programs.
All States and Territories except Alabama, Alaska, Colorado,
Connecticut, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana,
Nebraska, Oklahoma, Oregon, Virginia, Pennsylvania, South Dakota,
Washington, American Samoa and Palau have elected to participate in the
Executive Order process and have established Single Points of Contact
(SPOCs), listed at the end of this announcement. Applicants from these
nineteen jurisdictions need take no action regarding E.O. 12372.
Applicants for projects to be administered by Federally-recognized
Indian Tribes are also exempt from the requirements of E.O. 12372.
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 the program office can obtain and review
SPOC comments as part of the award process. It is imperative that the
applicant submit all required materials, if any, to the SPOC and
indicate the date of this submittal (or the date of contact if no
submittal is required) on the Standard Form 424, item 16a.
Under 45 CFR 100.8(a)(2), a SPOC has 60 days from the application
deadline to comment on proposed new or competing continuation awards.
SPOCs are encouraged to eliminate the submission of routine
endorsements as official recommendations. Additionally, SPOCs are
requested to clearly differentiate between mere advisory comments and
those official State process recommendations which may trigger the
``accommodate or explain'' rule.
When comments are submitted directly to ACF, they should be
addressed to: Department of Health and Human Services, Administration
for Children and Families, Division of Discretionary Grants, 370
L'Enfant Promenade, SW, Washington, DC. 20447.
B. Deadline for Submittal of Applications
Applications shall be considered as meeting an announced deadline
if they are either:
1. Received on or before the deadline date at the receipt point
specified in this program announcement, or
2. Sent on or before the deadline date and received by ACF in time
for the independent review. Applicants are cautioned to request a
legibly dated U.S. Postal Service postmark or to obtain a legibly dated
receipt from a commercial carrier or U.S. Postal Service. Private
[[Page 17070]] Metered postmarks shall not be acceptable as proof of
timely mailing.
Late applications: Applications which do not meet the criteria in 1
and 2 above are considered late applications. ACF shall notify each
late applicant that its application will not be considered in the
current competition.
Extension of deadlines: ACF 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 ACF
does not extend the deadline for all applicants, it will not extend the
deadline for any applicants.
C. Instructions for Preparing the Application
In order to assist applicants in completing the application, the
Standard Forms 424 and 424A, required certifications, and a list of
SPOCs have been included at the end of Part III of this announcement.
Please reproduce single-sided copies of these forms from the reprinted
forms and type your information onto the copies. Do not use forms
directly from the Federal Register announcement, as they are printed on
both sides of the page.
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.
Item 1. ``Type of Submission''--Non-Construction.
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. For applications developed jointly,
enter the name of the lead organization only. There must be a single
applicant for each application.
``Organizational Unit''--Enter the name of the primary unit within
the applicant organization which will actually carry out the project
activity. 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 of the person to be contacted on
matters involving this application (give area code)''--Enter the full
name and telephone number of a person who can respond to questions
about the application. This person should be accessible at the address
given.
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''--New.
Item 9. ``Name of Federal Agency''--DHHS/ACF.
Item 10. ``Catalog of Federal Domestic Assistance Number''--93.647.
Item 11. ``Descriptive Title of Applicant's Project''--Responsible
Fatherhood Project.
Item 12. ``Areas Affected by Project''--Self-explanatory.
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.
Items 15 ``Estimated Funding Levels''--In completing 15a through
15f, the dollar amounts entered should reflect the total amount
requested for the initial 17-month budget 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 available under this announcement for the initial 17-
month budget period.
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.''
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.
Item 15g. Enter the sum of items 15a-15e.
Item 16a. ``Is Application Subject to Review By State Executive
Order 12372 Process?--Check ``Yes'' if your State participates in the
E.O. 12372 process. Enter the date the application was made available
to the State for review. 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.
Item 16b. ``Is Application Subject to Review By State Executive
Order 12372 Process?--Check ``No'' if the program has not been selected
by 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 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, and C are to be completed. Sections D, E and F do not
need to be completed.
Section A--Budget Summary. Line 1:
Column (a): Enter ``Responsible Fatherhood'';
Column (b): Enter 93.647.
Columns (c) and (d): Leave blank.
Columns (e), (f) and (g): Enter the appropriate amounts needed to
support the project for the budget period.
Section B--Budget Categories. This budget should include the
Federal as well as non-Federal funding for the proposed project for the
budget period. [[Page 17071]] The budget 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.
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.
Justification: Provide a break-down of amounts and percentages that
comprise fringe benefit costs, such as health insurance, FICA,
retirement insurance, etc.
Travel--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 grants governed by the administrative
requirements of either 45 CFR Part 92 or 45 CFR Part 74, equipment is
defined as 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.
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.'' 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. In
the case of training grants to other than State or local governments
(as defined in title 45, Code of Federal Regulations, part 74), the
Federal reimbursement of indirect costs will be limited to the lesser
of the negotiated (or actual) indirect cost rate or 8 percent of the
amount allowed for direct costs, exclusive of any equipment charges,
rental of space, tuition and fees, post-doctoral training allowances,
contractual items, and alterations and renovations.
Justification: Enclose a copy of the indirect cost rate agreement,
if applicable.
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. On
lines 8-11, list estimates for each projected budget period within the
total project period (if an additional line is needed, use line 23 and
label it appropriately). Enter total amounts on line 12.
In-kind contributions are defined in title 45 of the Code of
Federal Regulations, Sec. 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 expendable 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. Not applicable
Section F--Other Budget Information. Not applicable.
3. Program Narrative Statement
The Program Narrative Statement should be clear, concise, and
address the specific requirements mentioned under Part I. The narrative
should also provide information concerning how the application meets
the evaluation criteria using the following headings:
(a) Organizational Experience;
(b) Staff Skills and Responsibilities; [[Page 17072]]
(c) Knowledge of Issues Concerning Fathers;
(d) Approach and Project Design;
(e) Budget Appropriateness.
The specific information to be included under each of these
headings is described in section B of Part II--Evaluation Criteria.
The narrative should be typed double-spaced. All pages of the
narrative (including charts, references, footnotes, tables, maps,
exhibits, etc.) must be sequentially numbered, beginning with
``Organizational Experience.'' The length of the application, including
the application forms and all attachments, should not exceed 50 pages.
4. 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; (2) Debarment and Other Responsibilities; and (3)
Certification Regarding Environmental Tobacco Smoke. These
certifications are self-explanatory. Copies of these assurances and
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 and certifications. A signature on the SF 424
indicates compliance with Drug-Free Workplace Requirements, Debarment
and Other Responsibilities, and 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 application, signed and dated, plus two copies.
--Complete application length should not exceed 60 pages.
--A complete application consists of the following items in this order:
Application for Federal Assistance (SF 424);
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);
Budget Justification for SF 424A Section B--Budget
Categories;
Letter from the Internal Revenue Service to prove
nonprofit status, if necessary;
Copy of the applicant's approved indirect cost rate
agreement, if appropriate;
Program Narrative Statement (See Part II, Section C);
Assurances--Non-construction programs (SF 424B); and
Certification Regarding Lobbying.
E. Submitting the Application
Each application package must include an original and two copies of
the complete application. Each copy should be stapled securely. All
pages of the narrative (including charts, tables, maps, exhibits, etc.)
must be sequentially numbered. In order to facilitate handling, please
do not use covers, binders, or tabs.
Applicant should include a self-addressed, stamped acknowledgment
card. All applicants will be notified automatically about the receipt
of their application.
Dated: March 28, 1995.
Howard Rolston,
Director, Office of Policy and Evaluation.
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BILLING CODE 4184-01-C
[[Page 17074]]
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 is 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 request 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
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BILLING CODE 4184-01-C
[[Page 17077]]
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 6 a-i--Show the totals of Lines 6a to 6h in each column.
Line 6j--Show the amount of indirect cost.
Line 6k--Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total amount
in column (5), Line 6k, should be the same as the total amount shown
in Section A, Column (g), Line 5. For supplemental grants and
changes to grants, the total amount of the increase or decrease as
shown in Columns (1)-(4), Line 6k should be the same as the sum of
the amounts in Section A, Columns (e) and (f) on Line 5.
Line 7--Enter the estimated amount of income, if any, expected
to be generated from this project. Do not add or subtract this
amount from the total project amount. Show under the program
narrative statement the nature and source of income. The estimated
amount of program income may be considered by the federal grantor
agency in determining the total amount of the grant.
Section C. Non-Federal Resources
Lines 8-11--Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.
Column (a)--Enter the program titles identical to Column (a),
Section A. A breakdown by function or activity is not necessary.
Column (b)--Enter the contribution to be made by the applicant.
Column (c)--Enter the amount of the State's cash and in-kind
contribution if the applicant is not a State or State agency.
Applicants which are a State or State agencies should leave this
column blank.
Column (d)--Enter the amount of cash and in-kind contributions
to be made from all other sources.
Column (e)--Enter totals of Columns (b), (c), and (d).
Line 12--Enter the total for each of Columns (b)-(e). The amount
in Column (e) should be equal to the amount on Line 5, Column (f),
Section A.
Section D. Forecasted Cash Needs
Line 13--Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14--Enter the amount of cash from all other sources needed
by quarter during the first year.
Line 15--Enter the totals of amounts on Lines 13 and 14.
Section E. Budget Estimates of Federal Funds Needed for Balance of the
Project
Lines 16-19--Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or activity
is not necessary. For new applications and continuation grant
applications, enter in the proper columns amounts of Federal funds
which will be needed to complete the program or project over the
succeeding funding periods (usually in years). This section needs
not be completed for revisions (amendments, changes, or supplements)
to funds for the current year of existing grants.
If more than four lines are needed to list the program titles,
submit additional schedules as necessary.
Line 20--Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21--Use this space to explain amounts for individual direct
object-class cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal
grantor agency.
Line 22--Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during the
funding period, the estimated amount of the base to which the rate
is applied, and the total indirect expense.
Line 23--Provide any other explanations or comments deemed
necessary.
Assurances--Non-Construction Programs
Note: Certain of these assurances may not be applicable to your
project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may
require applicants to certify to additional assurances. If such is
the case, you will be notified.
As the duly authorized representative of the applicant I certify
that the applicant:
1. Has the legal authority to apply for Federal assistance, and
the institutional, managerial and financial capability (including
funds sufficient to pay the non-Federal share of project costs) to
ensure proper planning, management and completion of the project
described in this application.
2. Will give the awarding agency, the Comptroller General of the
United States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records,
books, papers, or documents related to the award; and will establish
a proper accounting system in accordance with generally accepted
accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using
their positions for a [[Page 17078]] 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 under ground sources of drinking water
under the Safe Drinking Water Act of 1974; as amended, (P.L. 93-
523); and (h) protection of endangered species under the Endangered
Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16
U.S.C Secs. 1271 et seq.) related to protecting components or
potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with
Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470), EO 11593 (identification and protection of
historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and related
activities supported by this award of assistance.
15. will comply with the Laboratory Animal Welfare Act of 1996
(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
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Title
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Applicant Organization
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Date Submitted
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BILLING CODE 4184-01-P
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[[Page 17080]]
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BILLING CODE 4184-01-C
[[Page 17081]]
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 antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, or receiving stolen property;
(c) are not presently indicted or otherwise criminally or
civilly charged by a governmental entity (Federal, State or local)
with commission of any of the offenses enumerated in paragraph
(1)(b) of this certification; and
(d) have not within a 3-year period preceding this application/
proposal had one or more public transactions (Federal, State, or
local) terminated for cause or default.
The inability of a person to provide the certification required
above will not necessarily result in denial of participation in this
covered transaction. If necessary, the prospective participant shall
submit an explanation of why it cannot provide the certification.
The certification or explanation will be considered in connection
with the Department of Health and Human Services (HHS) determination
whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an
explanation shall disqualify such person from participation in this
transaction.
The prospective primary participant agrees that by submitting
this proposal, it will include the clause entitled ``Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion--Lower Tier Covered Transaction.'' Provided below without
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion--Lower Tier Covered Transactions
(To Be Supplied to Lower Tier Participants)
By signing and submitting this lower tier proposal, the
prospective lower tier participant, as defined in 45 CFR Part 76,
certifies to the best of its knowledge and belief that it and its
principals:
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any federal department or
agency.
(b) where the prospective lower tier participant is unable to
certify to any of the above, such prospective participant shall
attach an explanation to this proposal.
The prospective lower tier participant further agrees by
submitting this proposal that it will include this clause entitled
``Certification Regarding Debarment, Suspension, Ineligibility, and
Voluntary Exclusion--Lower Tier Covered Transactions'' without
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative
Agreements
The undersigned certifies, to the best of his or her knowledge
and belief, that:
(1) No Federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee 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 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
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Title
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Organization
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Date
BILLING CODE 4184-01-P
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BILLING CODE 4184-01-C
[[Page 17083]]
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.
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 (302) 736-3326
District of Columbia
Rodney T. Hallman, State Single Point of Contact, Office of Grants
Management and Development, 717 14th Street NW., Suite 500,
Washington, DC 20005, Telephone (202) 727-6551
Florida
Florida State Clearinghouse, Intergovernmental Affairs Policy Unit,
Executive OFfice of the Governor, Office of Planning and Budgeting,
The Capitol, Tallahassee, Florida 32399-0001, Telephone (904) 488-
8441.
Georgia
Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse,
254 Washington Street SW., Atlanta, Georgia 30334, Telephone (404)
656-3855
Illinois
Steve Klokkenga, State Single Point of Contact, Office of the
Governor, 107 Stratton Building, Springfield, Illinois 62706,
Telephone (217) 782-1671
Indiana
Jean S. Blackwell, Budget Director, State Budget Agency, 212 State
House, Indianapolis, Indiana 46204, Telephone (317) 232-5610
Iowa
Mr. Steven R. McCann, Division of Community Progress, Iowa
Department of Economic Development, 200 East Grand Avenue, Des
Moines, Iowa 50309, Telephone (515) 281-3725
Kentucky
Ronald W. Cook, Office of the Governor, Department of Local
Government, 1024 Capitol Center Drive, Frankfort, Kentucky 40601,
Telephone (502) 564-2382
Maine
Ms. Joyce Benson, State Planning Office, State House Station #38,
Augusta, Maine 04333, Telephone (207) 289-3261
Maryland
Ms. Mary Abrams, Chief, Maryland State Clearinghouse, Department of
State Planning, 301 West Preston Street, Baltimore, Maryland 21201-
2365, Telephone (301) 225-4490
Massachusetts
Karen Arone, State Clearinghouse, Executive Office of Communities
and Development, 100 Cambridge Street, Room 1803, Boston,
Massachusetts 02202, Telephone (617) 727-7001
Michigan
Richard S. Pastula, Director, Michigan Department of Commerce,
Lansing, Michigan 48909, Telephone (517) 373-7356
Mississippi
Ms. Cathy Mallette, Clearinghouse Officer, Office of Federal Grant
Management and Reporting, 301 West Pearl Street, Jackson,
Mississippi 39203, Telephone (601) 960-2174
Missouri
Ms. Lois Pohl, Federal Assistance Clearinghouse, Office of
Administration, P.O. Box 809, Room 430, Truman Building, Jefferson
City, Missouri 65102, Telephone (314) 751-4834
Nevada
Department of Administration, State Clearinghouse, Capitol Complex,
Carson City, Nevada 89710, Telephone (702) 687-4065, Attention: Ron
Sparks, Clearinghouse Coordinator
New Hampshire
Mr. Jeffrey H. Taylor, Director, New Hampshire Office of State
Planning, Attn: Intergovernmental Review Process/James E. Bieber,
2\1/2\ Beacon Street, Concord, New Hampshire 03301, Telephone (603)
271-2155
New Jersey
Gregory W. Adkins, Action 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 Capital,
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, 1204 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 [[Page 17084]]
Texas
Mr. Thomas Adams, Governor's Office of Budget and Planning, PO 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, PO 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, PO Box 2950, Agana, Guam 96910,
Telephone (617) 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, PO 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
[FR Doc. 95-8131 Filed 4-3-95; 8:45 am]
BILLING CODE 4184-01-P