[Federal Register Volume 61, Number 173 (Thursday, September 5, 1996)]
[Notices]
[Pages 46994-47009]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22604]



[[Page 46993]]


_______________________________________________________________________

Part IV





Department of Health and Human Services





_______________________________________________________________________



Administration for Children and Families



_______________________________________________________________________



Availability of Financial Assistance for the Mitigation of 
Environmental Impacts to Indian Lands Due to Department of Defense 
Activities; Notice

  Federal Register / Vol. 61, No. 173 / Thursday, September 5, 1996 / 
Notices  

[[Page 46994]]



DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families
[Program Announcement No. 93612-972]


Availability of Financial Assistance for the Mitigation of 
Environmental Impacts to Indian Lands Due to Department of Defense 
(DOD) Activities

AGENCY: Administration for Native Americans (ANA), Administration for 
Children and Families (ACF), Department of Health and Human Services 
(DHHS).

ACTION: Announcement of availability of competitive financial 
assistance to assist eligible applicants address environmental problems 
and impacts from DOD activities to Indian lands.

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DEFINITION: For purposes of this program announcement, Indian land is 
defined as all lands used by American Indian tribes and Alaska Native 
Villages.

SUMMARY: The Congress has recognized that DOD activities may have 
caused environmental problems for Indian tribes and Alaska Natives. 
These environmental hazards can negatively impact the health and safety 
as well as the social and economic welfare of Indian tribes and Alaska 
Natives. Accordingly, the Congress has taken steps to help those 
affected begin to mitigate environmental impacts from DOD activities by 
assisting them in the planning, development and implementation of 
programs for such mitigation.
    This environmental mitigation program was begun through a program 
announcement published on December 29, 1993 as a response to the 
Department of Defense Appropriations Act, Pub.L. 103-139, which was 
enacted on November 11, 1993. This program continues under Pub.L. 103-
335 (the Act), enacted on September 30, 1994. Section 8094A of the Act 
states, ``Of the funds appropriated to the Department of Defense (DOD) 
for Operations and Maintenace Defense-Wide, not less than $8,000,000 
shall be made available until expended to the Administration for Native 
Americans within 90 days of enactment of this Act: Provided That such 
funds shall be made available only for the mitigation of environmental 
impacts, including training and technical assistance to tribes, related 
administrative support, the gathering of information, documenting of 
environmental damage, and developing a system for prioritizing of 
mitigation, on Indian lands resulting from Department of Defense 
activities: Provided further, That the Department of Defense shall 
provide to the Committees on Appropriations of the Senate and House of 
Representatives by September 30, 1995, a summary report of all 
environmental damage that has occurred on Indian land as a result of 
DOD activities, to include, to the extent feasible, a list of all 
documents and records known to the Department that describe the 
activity or action causing or relating to such environmental damage.'' 
The Administration for Native Americans (ANA) and the Department of 
Defense (DOD) announce the availability of remaining FY 95 funds for 
eligible applicants to begin or continue the process of addressing the 
environmental problems and damage caused from DOD activities.

FOR FURTHER INFORMATION CONTACT: Sharon McCully--(202) 690-5780 or John 
Bushman--(202) 690-6234 at the Administration for Native Americans, 
Department of Health and Human Services, 200 Independence Avenue, S.W., 
Rm 348F, Washington, D.C. 20201-0001.

DATES: The closing dates for submission of applications is November 8, 
1996 and November 7, 1997.

A. Introduction and Purpose

    The program announcement states the availability of unobligated FY 
1995 funds to provide financial assistance to eligible applicants for 
the purpose of mitigating environmental impacts on Indian lands related 
to DOD activities.
    Financial assistance awards made under this program announcement 
will be on a competitive basis and the proposals will be reviewed 
against the evaluation criteria contained in this announcement.
    The Federal government recognizes that substantial environmental 
problems, resultant from defense activities, exist on Indian lands and 
will geographically range from border to border and from coast to 
coast. The nature and magnitude of the problems will most likely be 
better defined when affected Indian tribes and Alaska Natives have 
completed environmental assessments called for in Phase I of this four-
phase program.
    The Federal government has also recognized that Indian tribes, 
Alaska Natives and their tribal organizations must have the opportunity 
to develop their own plans and technical capabilities and access the 
necessary financial and technical resources in order to assess, plan, 
develop and implement programs to mitigate any impacts caused by DOD 
activities.
    The ANA and the DOD recognize the potential environmental problems 
created by DOD activities that may affect air, water, soil and human 
and natural resources (i.e., forests, fish, plants). It is also 
recognized that potential applicants may have specialized knowledge and 
capabilities to address specific concerns at various levels within the 
four phase program. Under this announcement proposals will be accepted 
for any and all of the four phases or one specific phase. These phases 
are: Phase I--assessment of Indian lands to develop as complete an 
inventory as possible of environmental impacts caused by DOD 
activities; Phase II--identification and exploration of alternative 
means for mitigation of these impacts and determination of the 
technical merit, feasibility and expected costs and benefits of each 
approach in order to select one approach; Phase III--development of a 
detailed mitigation plan, and costing and scheduling for implementation 
of the design, including strategies for meeting statutory or regulatory 
requirements and for dealing with other appropriate Federal agencies; 
and, Phase IV--implementation of the mitigation plan.
    The following are some known areas of concern. It is expected that 
applicants may identify additional areas of concern in their 
applications:
     Damage to treaty protected spawning habitats caused by 
artillery practice or other defense activities;
     Damage to Indian lands and improvements (e.g. wells, 
fences) and facilities caused by bombing practice;
     Damage caused to range and forest lands by gunnery range 
activities;
     Low-level flights over sacred sites and religious 
ceremonies which disrupt spiritual activities;
     Movement of soil covering the remains of buried Indian 
people and artifacts requiring, by tradition, their reburial in 
traditional rituals;
     Operation of dams by the Army Corps of Engineers which has 
had adverse impacts on spawning beds and treaty fishing rights and 
water quality due to problems of siltation; reduced stream flows; 
increased water temperatures; and, dredge and fill problems;
     Leaking of underground storage tanks on lands taken from 
Indians for temporary war-time use by the DOD;
     Unexploded ordnance from gunnery and bombing practice on 
Indian lands resulting in significant damage to rangelands, wildlife 
habitat, stock water wells, etc.;
     Disposal activities related to removal of unexploded 
ordnance, nuclear waste materials, toxic materials,

[[Page 46995]]

and biological warfare materials from Indian lands;
     Transportation of live ordnance, nuclear waste, chemical 
and biological warfare materials from and across Indian lands;
     Seepage of fluids suspected of containing toxic materials 
onto Indian lands;
     Chlorofluorocarbons (CFC's) resulting from abandoned 
containers and/or dumping onto Indian lands;
     Polychlorinated biphenyls (PCB's) from transformers which 
have been abandoned and/or dumped onto Indian lands;
     Public health concerns regarding electromagnetic fields 
surrounding Defense-related transmission facilities which cross Indian 
lands; and
     Reclamation activities required to mitigate any or all of 
the above stated conditions and other activities as they become known.

B. Proposed Projects To Be Funded With Unobligated FY 1995 Funds

    The purpose of this announcement is to invite single year (up to 
seventeen months in duration) or up to thirty-six month proposals from 
eligible applicants to undertake any or all of the Phases. Applicants 
may apply for projects of up to 36 months duration. A multi-year 
project, requiring more than 12 months to develop and complete, affords 
applicants the opportunity to develop more complex and in-depth 
projects. Funding after the first 12 month budget period of an approved 
multi-year project is non-competitive and subject to availability of 
funds. (see Part E for further information)
    Phase I: The purpose of Phase I is to conduct the research and 
planning needed to identify environmental impacts to Indian lands 
caused by DOD activities on or near Indian lands and to plan for 
remedial investigations to determine and carry out a preliminary 
assessment of these problems. These activities may include, but not be 
limited to, the following:
     Conduct site inspections to identify problems and causes 
related to DOD activities;
     Identify and develop approaches to handle raw data that 
will assist in performing comprehensive environmental assessments of 
problems and causes related to DOD activities;
     Identify approaches and develop methodologies which will 
be used to develop the activities to be undertaken in Phases II and 
III;
     Identify other Federal agency programs, if any, that must 
be involved in mitigation activities and their requirements;
     Identify potential technical assistance and expertise 
required to address the activities to be undertaken in Phases II and 
III; and
     Identify other Federal environmental restoration programs 
that could be accessed to cooperatively coordinate and mobilize 
resources in addressing short and long-term activities developed under 
Phase III.

Phase I should result in adequately detailed documentation of the 
problems and sources of help in solving them to provide a useful basis 
for examining alternative mitigation approaches in Phase II.
    Phase II: The purpose of Phase II activities is to examine 
alternative approaches for mitigation of the impacts identified in 
Phase I and to lead toward the mitigation design to be developed in 
Phase III. Phase II activities may include, but need not be limited to 
the following:
     Conduct remedial investigation and/or feasibility studies 
as necessary;
     Plan for the design of a comprehensive mitigation strategy 
to address problems identified during Phase I which address areas such 
as land use restoration, clean-up processes, contracting and liability 
concerns; regulatory responsibilities; and resources necessary to 
implement clean up actions;
     Design strategies that coordinate with or are 
complementary to existing DOD cleanup programs such as the Defense 
Environmental Restoration Program which promotes and coordinates 
efforts for the evaluation and cleanup of contamination at DOD 
installations;
     Review possible interim remedial strategies that address 
immediate potential hazards to the public health and environment in 
order to provide alternative measures i.e., providing alternate water 
supplies, removing concentrated sources of contaminants, or 
constructing structures to prevent the spread of contamination;
     Identify specific types of technical assistance and 
management expertise required to assist in developing specific 
protocols for environmental assessments, remedial investigations, 
feasibility studies, interim remedial actions and strategic planning 
for existing and future mitigation activities;
     Review other types of assessments that need to be 
considered, reviewed and incorporated into the conduct and/or design 
process such as:

--Estimates of clean-up cost;
--Estimate of impacts of short-term approach;
--Estimate of impacts of long-term approach;
--Cultural impacts;
--Economic impacts;
--Human health-risk impacts; and
     Document approaches and procedures which have been 
developed in order to negotiate with appropriate Federal agencies for 
necessary cleanup action and to keep the public informed.
    In establishing the basis for a design process, particularly when 
there are multiple problems, the applicants may want to consider a 
prioritization process as follows:
     Emergency situations that require immediate clean-up;
     Time-critical sites, i.e. sites where the situation will 
deteriorate if action is not taken soon;
     Projects with minimum funding requirements;
     Projects with intermediate-level funding requirements;
     Projects with maximum funding requirements.
    Achieving compliance with Federal environmental protection 
legislation is the driving force behind all Federal clean-up 
activities. The following is a list of major Federal environmental 
legislation that should be recognized in a regulatory review as all 
Federal, state and local regulatory requirements which could have major 
impacts in the design of mitigation strategies:
     Indian Environmental General Assistance Program Act of 
1992;
     Clean Air Act (CAA);
     Clean Water Act (CWA);
     Safe Drinking Water Act (SDWA);
     Surface Mining Control and Reclamation Act of 1977 
(SMCRA);
     Marine Protection, Research and Sanctuaries Act of 1972 
(MPRSA);
     Toxic Substances Control Act (TSCA);
     Federal Insecticide, Fungicide, and Rodenticide Act 
(FIFRA);
     Nuclear Waste Policy Act of 1982 (NWPA);
     Comprehensive Environmental Resource Conservation and 
Liability Act (CERCLA or Superfund);
     Resource Conservation and Recovery Act of 1976 (RCRA);
     Hazardous and Solid Waste Amendments of 1984 (HSWA);
     National Environmental Policy Act of 1969 (NEPA); Other 
Federal legislation that should be included in the regulatory review 
and that should be of assistance are the tribal specific legislative 
acts, such as:
     American Indian Religious Freedom Act;
     National Historic Preservation Act of 1991;
     Indian Environmental Regulatory Enhancement Act of 1990;

Other regulatory considerations could involve applicable tribal, 
village, state

[[Page 46996]]

and local laws, codes, ordinances, standards, etc. which should also be 
reviewed to assist in planning, the mitigation design, and development 
of the comprehensive mitigation strategy.
    Phase II should result in a carefully documented examination of 
alternative approaches and the selection of an approach to be used in 
the Phase III design process.
    Phase III: The purpose of Phase III is the completion of activities 
initiated under Phase II, the initiation of new activities required to 
implement programs, and the design of on-site actions required to 
mitigate environmental damage from DOD activities.
    The Phase III activities may include but need not be limited to:
     Development and implementation of a detailed management 
plan to: guide corrective action; resolve issues rising from 
overlapping or conflicting jurisdictions; guide a cooperative and 
collaborative effort among all parties to ensure there are no 
duplicative or conflicting regulatory requirements governing the 
cleanup actions; and, establish a tribal or village framework and/or 
parameter(s) that will guide the negotiations process for one or 
multiple cleanup actions;
     Establishment of priorities for mitigation programs when 
there are multiple clean-up sites; consider at a minimum the nature of 
the hazard involved: such as its physical and chemical characteristics, 
including concentrations and mobility of contaminants; the pathway 
indicating potential for contaminant transport via surface water, 
ground water and air/soil, and any other indicators that are identified 
during the environmental assessment, including the prioritization 
process identified under Phase II;
     Program design and implementation of information 
dissemination strategies prior to start up of on-site implementation of 
mitigation program activities;
     Development of a legal and jurisdictional strategy that 
addresses DOD/contractor liability issues to ensure quality, cost-
effective mitigation services, and to evaluate any measures providing 
equitable risk between the DOD and the remediation contractor, as well 
as to incorporate Tribal Employment Rights Office (TERO) and other 
policies and procedures, if required;
     Design of an approval process and other processes 
necessary for the implementation of tribal and village codes and 
regulations for current and future compliance enforcement of all 
mitigation actions;
     Development/design of a documentation strategy to ensure 
all DOD and contractor cleanup activities are conducted and completed 
in a environmentally clean and safe manner for the social and economic 
welfare, as well as public health of Indian and Alaska Native people 
and the surrounding environment;
     Development and conduct of certified training programs 
that will enable a local work force to become technically capable to 
participate in the mitigation activities, if they so choose; and
     Conduct of any other activities deemed necessary to carry 
out Phases I, II and III activities.

Phase III should result in a comprehensive plan for conducting all 
aspects of mitigation action contemplated.
    Phase IV: The Phase IV activities are the implementation of 
mitigation plans specified in the detailed plan completed in Phase III.

C. Eligible Applicants

    The following organizations are eligible to apply:
     Federally recognized Indian tribes;
     Incorporated Non-Federally and State recognized Indian 
tribes;
     Alaska Native villages, tribes or tribal governing bodies 
(IRA or traditional councils) as recognized by the Bureau of Indian 
Affairs;
     Nonprofit Alaska Native Regional Associations and/or 
Corporations with village specific projects;
     Nonprofit Native Organizations in Alaska with village 
specific projects;
     Other tribal or village organizations or consortia of 
Indian tribes.

In addition, current ANA grantees who meet the above eligibility 
criteria, but do not have a mitigation grant under Program Announcement 
93612-952 are also eligible to apply for a grant award under this 
program announcement.

D. Available Funds

    Subject to availability of funds, approximately $7 million of 
financial assistance is available under this program announcement for 
eligible applicants. All remaining unobligated FY 95 funds will be 
available for this purpose. It is expected that about 25 awards will be 
made, ranging from $100,000 to $1 million. Each eligible applicant 
described above (Part C) can receive only one grant award under this 
announcement.

E. Multi-Year Projects

    This announcement is soliciting applications for project periods up 
to 36 months. Awards, on a competitive basis, will be for a one-year 
budget period, although project periods may be as long as 36 months. 
Funding after the 12 month budget period of an approved multi-year 
project is non-competitive. The non-competitive funding for the second 
and third years is contingent upon the grantee's satisfactory progress 
in achieving the objectives of the project according to the approved 
work plan, the availability of Federal funds, compliance with the 
applicable statutory, regulatory and grant requirements, and 
determination that continued funding is in the best interest of the 
Government.

F. Grantee Share of Project

    Grantees must provide at least five (5) 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. The funds for the match must be from a private source, 
or state source where the funds were not obtained from the Federal 
government by the state, or a Federal source where legislation or 
regulation authorizes the use of these funds for matching purposes. 
Therefore, a project requesting $300,000 in Federal funds (based on an 
award of $100,000 per budget period), must include a match of at least 
$15,789 (5% total project cost). Applicants may request a waiver of the 
requirement for a 5% non-Federal matching share. Since the matching 
requirement is very low it is not expected that waivers will be 
requested. However, the procedure for requesting a waiver can be found 
in 45 CFR 1336, Subpart E- Financial Assistance Provisions.
    It is the policy of ANA to apply the waiver of the non-Federal 
matching share requirement for the purposes of this particular program 
announcement.

G. Intergovernmental Review of Federal Programs

    This program is not covered by Executive Order 12372.

H. Application Process

    (1) Availability of Application Forms: In order to be considered 
for a grant under this program announcement, an application must be 
submitted on the forms supplied, including Form-424, and in the manner 
prescribed by ANA. The application kits containing the necessary forms 
and instructions may be obtained from: Department of Health and Human 
Services,Administration for

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Children and Families, Administration for Native Americans, Room 348F, 
Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, 
D.C. 20201-0001, (202) 690-7776.
    (2) Application Submission: Each application should include one 
signed original and two (2) copies of the grant application, including 
all attachments. Assurances and certifications must be completed. 
Submission of the application constitutes certification by the 
applicant that it is in compliance with Drug-Free Workplace and 
Debarment and these forms do not have to be submitted. The application 
must be hand delivered or mailed by the closing date to: Department of 
Health and Human Services, Administration for Children and Families, 
Administration for Native Americans, Rm 348-F, 200 Independence Avenue, 
S.W., Washington, D.C. 20201-0001, Attn: 93612-972.
    Hand delivered applications are accepted during the normal working 
hours of 8:00 a.m. to 4:30 p.m., Monday through Friday, on or prior to 
the established closing date at the Administration for Children and 
Families, Administration for Native Americans, 200 Independence Avenue, 
S.W. Washington, D.C. 20201-0001.
    The application must be signed by an individual authorized: 1) to 
act for the applicant tribe, village or organization, and 2) to assume 
the applicant's obligations under the terms and conditions of the grant 
award.
    (3) Application Consideration: The Commissioner of the 
Administration for Native Americans determines the final action to be 
taken with respect to each grant application received under this 
announcement. The following points should be taken into consideration 
by all applicants:
     Incomplete applications and applications that do not 
otherwise conform to this announcement will not be accepted for review. 
Applicants will be notified in writing of any such determination by 
ANA.
     Complete applications that conform to all the requirements 
of this program announcement are subjected to a competitive review and 
evaluation process. An independent review panel consisting of reviewers 
familiar with environmental problems of Indian tribes and Alaska Native 
villages will evaluate each application against the published criteria 
in this announcement. The results of this review will assist the 
Commissioner in making final funding decisions.
     The Commissioner's decision will also take into account 
the comments of ANA staff, state and Federal agencies having 
performance related information, and other interested parties.
     As a matter of policy the Commissioner will make grant 
awards consistent with the stated purpose of this announcement and all 
relevant statutory and regulatory requirements under 45 CFR Parts 74 
and 92 applicable to grants under this announcement.
     After the Commissioner has made decisions on all 
applications, unsuccessful applicants will be notified in writing 
within approximately 120 days of the closing date. Successful 
applicants are notified through an official Financial Assistance Award 
(FAA) document. The Administration for Native Americans staff cannot 
respond to requests for funding decisions prior to the official 
notification to the applicants. The FAA will state the amount of 
Federal funds awarded, the purpose of the grant, the terms and 
conditions of the grant award, the effective date of the award, the 
project period, the budget period, and the amount of the non-Federal 
matching share requirement.

I. Review Process

1. Initial Application Review

    Applications submitted by the closing date and verified by the 
postmark date under this program announcement will undergo a pre-review 
to determine that:
     The applicant is eligible in accordance with the Eligible 
Applicants Section of this announcement.
     The application materials submitted are sufficient to 
allow the panel to undertake an in-depth evaluation (All required 
materials and forms are listed in the Grant Application Checklist.)

2. Competitive Review of Accepted Applications

    Applications which pass the pre-review will be evaluated and rated 
by an independent review panel on the basis of the evaluation criteria. 
These criteria are used to evaluate the quality of a proposed project, 
and to determine the likelihood of its success.

3. Determination of Ineligibility

    Applicants who are initially rejected from competitive evaluation 
because of ineligibility, may appeal an ANA decision of applicant 
ineligibility. Likewise, applicants may also appeal an ANA decision 
that an applicant's proposed activities are ineligible for funding 
consideration. The appeals process is stated in the final rule 
published in the Federal Register on August 19, 1996 (61 FR 42817).

J. Review Criteria

    A proposed project should reflect the purposes stated and described 
in the Introduction and Program Purpose (Section A) of this 
announcement. No additional weight or preference is given to 
applications because of an increased number of phases proposed. Also, 
competition is not based on proposals of the same phase or phases but 
on the merit of the application independent of phase consideration. The 
evaluation criteria are:
    (1) Goals and Available Resources (15 points):
    (a) The application presents specific mitigation goals related to 
the proposed project. It explains how the tribe or village intends to 
achieve those goals identified in the application and clearly documents 
the involvement and support of the community in the planning process 
and implementation of the proposed project. The above requirement may 
be met by submission of a resolution by a tribe or tribal organization 
stating that community involvement has occured in the project planning 
and will occur in the implementation of the project.
    (b) Available resources (other than ANA) which will assist, and be 
coordinated with the project are described. These resources may be 
personnel, facilities, vehicles or financial and may include other 
Federal and non-Federal resources.
    (2) Organizational Capabilities and Qualifications (10 points).
    (a) The management and administrative structure of the applicant is 
explained. Evidence of the applicant's ability to manage a project of 
the proposed scope is well defined. The application clearly 
demonstrates the successful management of prior or current projects of 
similar scope by the organization and/or by the individuals designated 
to manage the project.
    (b) Position descriptions or resumes of key personnel, including 
those of consultants, are presented. The position descriptions and 
resumes relate specifically to the staff proposed in the Approach Page 
and in the proposed Budget of the application. Position descriptions 
very clearly describe the position and its duties and clearly relate to 
the personnel staffing required for implementation of the project 
activities. Either the position descriptions or the resumes present the 
qualifications that the applicant believes are necessary for overall 
quality management of the project.
    (3) Project Objectives, Approach and Activities (45 points). The 
Objective Work Plan in the application includes

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project objectives and activities related to the long term goals for 
each budget period proposed and demonstrates that these objectives and 
activities:
     Are measurable and/or quantifiable;
     Are based on a fully described and locally determined 
balanced strategy for mitigation of impacts to the environment;
     Clearly relate to the tribe or village long-range goals 
which the project addresses;
     Can be accomplished with available or expected resources 
during the proposed project period;
     Indicate when the objective, and major activities under 
each objective will be accomplished;
     Specify who will conduct the activities under each 
objective; and
     Support a project that will be completed, self-sustaining, 
or financed by other than ANA funds at the end of the project period.
    (4) Results or Benefits Expected (20 points). The proposed project 
will result in specific measurable outcomes for each objective that 
will clearly contribute to the completion of the project and will help 
the tribe or village meet its goals. The specific information provided 
in the application on expected results or benefits for each objective 
is the basis upon which the outcomes can be evaluated at the end of 
each budget year.
    (5) Budget (10 points).
    There is a detailed budget provided for each budget period 
requested. (This is especially necessary for multi-year applications.) 
The budget is fully explained. It justifies each line item in the 
budget categories in Section B of the Budget Information of the 
application, including the applicant's non-Federal share and its 
source. Sufficient cost and other detail is included and explained to 
facilitate the determination of cost allowability and the relevance of 
these costs to the proposed project. The funds requested are 
appropriate and necessary for the scope of the project.

K. Guidance to Applicants

    The following is provided to assist applicants to develop a 
competitive application.
    (1) Program Guidance:
     The Administration for Native Americans will fund projects 
that present the strongest prospects for meeting the stated purposes of 
this program announcement. Projects will not be funded on the basis of 
need alone.
     In discussing the problems being addressed in the 
application, relevant historical data should be included so that the 
appropriateness and potential benefits of the proposed project will be 
better understood by the reviewers and decision-maker.
     Supporting documentation, if available, should be included 
to provide the reviewers and decision-maker with other relevant data to 
better understand the scope and magnitude of the project.
     The applicant should provide documentation showing support 
for the proposed project from authorized officials, board of directors 
and/or officers through a letter of support or resolution. It would be 
helpful, particularly for organizations, to delineate the membership, 
make-up of the board of directors, and its elective procedures to 
assist reviewers in determining authorized support.
    (2) Technical Guidance.
     Applicants are strongly encouraged to have someone other 
than the author apply the evaluation criteria in the program 
announcement and to score the application prior to its submission, in 
order to gain a better sense of its quality and potential 
competitiveness in the review process.
     ANA will accept only one application under this program 
announcement from any one applicant. If an eligible applicant sends two 
applications, the one with the earlier postmark will be accepted for 
review unless the applicant withdraws the earlier application.
     An application from an Indian tribe, Alaska Native Village 
or other eligible organization must be submitted by the governing body 
of the applicant.
     The application's Form 424 must be signed by the 
applicant's representative (tribal official or designate) who can act 
with full authority on behalf of the applicant.
     The Administration for Native Americans suggests that the 
pages of the application be numbered sequentially from the first page 
and that a table of contents be provided. The page numbering, along 
with simple tabbing of the sections, would be helpful and allows easy 
reference during the review process.
     Two (2) copies of the application plus the original are 
required.
     The Cover Page should be the first page of an application, 
followed by the one-page abstract.
     Section B of the Program Narrative should be of sufficient 
detail as to become a guide in determining and tracking project goals 
and objectives.
     The applicant should specify the entire length of the 
project period on the first page of the Form 424, Block 13, not the 
length of the first budget period. ANA will consider the project period 
specified on the Form 424 as governing.
     Line 15a of the Form 424 should specify the Federal funds 
requested for the first Budget period, not the entire project period.
     Applicants proposing multi-year projects need to describe 
and submit project objective workplans and activities for each budget 
period. (Separate itemized budgets for the Federal and non-Federal 
costs should be included).
     Applicants for multi-year projects must justify the entire 
time-frame of the project and also project the expected results to be 
achieved in each budget period and for the total project period.
    (3) Projects or activities that generally will not meet the 
purposes of this announcement.
     Proposals from consortia of tribes or villages that are 
not specific with regard to support from, and roles of member tribes.
     The purchase of real estate or construction.

L. Paperwork Reduction Act of 1995

    Under the Paperwork Reduction Act of 1995, Pub. L. 104-13, the 
Department is required to submit to the Office of Management and Budget 
(OMB) for review and approval any reporting and record keeping 
requirements in regulations including program announcements. This 
program announcement does not contain information collection 
requirements beyond those approved for ANA grant applications under the 
Program Narrative Statement by OMB.

M. Due Date for Receipt of Applications

    The closing date for applications submitted in response to this 
program announcement are November 8, 1996 and November 7, 1997.

N. Receipt of Applications

    Applications must either be hand delivered or mailed to the address 
in Section H, Application Process: Application Submission.
    The Administration for Native Americans will not accept 
applications submitted electronically nor via facsimile (FAX) 
equipment.
    Deadline: Applications shall be considered as meeting the announced 
deadline if they are either:
    1. Received on or before the deadline date at the place specified 
in the program announcement, or
    2. Sent on or before the deadline date and received by the granting 
agency in the time for the independent review under DHHS GAM Chapter 1-
62 (Applicants are cautioned to request a legibly dated U.S. Postal 
Service postmark or to obtain a legibly dated

[[Page 46999]]

receipt from a commercial carrier or U.S. Postal Service. Private 
Metered postmarks shall not be acceptable as proof of timely mailing.)
    Late Applications. Applications which do not meet the criteria 
above are considered late applications. The granting agency shall 
notify each late applicant that its application will not be considered 
in the current competition.
    Extension of Deadlines. The granting agency may extend the deadline 
for all applicants because of acts of God such as floods, hurricanes, 
etc., or when there is a widespread disruption of the mails. However, 
if the granting agency does not extend the deadline for all applicants, 
it may not waive or extend the deadline for any applicants.

(Catalog of Federal Domestic Assistance Program Number 93.612 Native 
American Programs)

    Dated: August 27, 1996.
Gary N. Kimble,
Commissioner, Administration for Native Americans.

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Instructions for the SF 424

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

Item and Entry

    1. Self-explanatory.
    2. Date application submitted to Federal agency (or State if 
applicable) & applicant's control number (if applicable).
    3. State use only (if applicable).
    4. If this application is to continue or revise an existing 
award, enter present Federal identifier number. If for a new 
project, leave blank.
    5. Legal name of applicant, name of primary organizational unit 
which will undertake the assistance activity, complete address of 
the applicant, and name and telephone number of the person to 
contact on matters related to this application.
    6. Enter Employer Identification Number (EIN) as assigned by the 
Internal Revenue Service.
    7. Enter the appropriate letter in the space provided.
    8. Check appropriate box and enter appropriate letter(s) in the 
space(s) provided.

--``New'' means a new assistance award.
--``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
--``Revision'' means any change in the Federal Government's 
financial obligation or contingent liability from an existing 
obligation.

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

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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 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 heading on each sheet. For each program, 
function or activity, fill in the total requirements for funds (both 
Federal and non-Federal) by object class categories.
    Lines 6a-i--Show the totals of Lines 6a to 6h in each column.
    Line 6j--Show the amount of indirect cost.
    Line 6k--Enter the total of amounts on Lines 6i and 6j. For all 
applications for new grants and continuation grants the total amount 
in column (5), Line 6k, should be the same as the total amount shown 
in Section A, Column (g), Line 5. For supplemental grants and 
changes to grants, the total amount of the increase or decrease as 
shown in Columns (1)-(4), Line 6k should be the same as the sum of 
the amounts in Section A, Columns (e) and (f) on Line 5.
    Line 7--Enter the estimated amount of income, if any, expected 
to be generated from this project. Do not add or subtract this 
amount from the total project amount. Show under the program 
narrative statement the nature and source of income. The estimated 
amount of program income may be considered by the federal grantor 
agency in determining the total amount of the grant.

Section C. Non-Federal-Resources

    Lines 8-11--Enter amounts of non-federal resources that will be 
used on the grant. If in-kind contributions are included, provide a 
brief explanation on a separate sheet.
    Column (a)--Enter the program titles identical to Column (a), 
Section A. A breakdown by function or activity is not necessary.
    Column (b)--Enter the contribution to be made by the applicant.
    Column (c)--Enter the amount of the State's cash and in-kind 
contribution if the applicant is not a State or State agency. 
Applicants which are a State or State agencies should leave this 
column blank.
    Column (d)--Enter the amount of cash and in-kind contributions 
to be made from all other sources.
    Column (e)--Enter 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 duty 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,

[[Page 47005]]

or documents related to the award; and will establish a proper 
accounting system in accordance with generally accepted accounting 
standards or agency directives.
    3. Will establish safeguards to prohibit employees from using 
their positions for a purpose that constitutes or presents the 
appearance of personal or organizational conflict of interest, or 
personal gain.
    4. Will initiate and complete the work within the applicable 
time frame after receipt of approval of the awarding agency.
    5. Will comply with the Intergovernmental Personnel Act of 1970 
(42 U.S.C. Secs. 4728-4763) relating to prescribed standards for 
merit systems for programs funded under one of the nineteen statutes 
or regulations specified in Appendix A of OPM's Standards for a 
Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
    6. Will comply with all Federal statutes relating to 
nondiscrimination. These include but are not limited to: (a) Title 
VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits 
discrimination on the basis of race, color or national origin; (b) 
Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 
Secs. 1681-1683, and 1685-1686), which prohibits discrimination on 
the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, 
as amended (29 U.S.C. Sec.  794), which prohibits discrimination on 
the basis of handicaps; (d) the Age Discrimination Act of 1975, as 
amended (42 U.S.C. Secs. 6101-6107), which prohibits discrimination 
on the basis of age; (e) the Drug Abuse Office and Treatment Act of 
1972 (P.L. 92-255), as amended, relating to nondiscrimination on the 
basis of drug abuse; (f) the Comprehensive Alcohol Abuse and 
Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 
(P.L. 91-616), as amended, relating to nondiscrimination on the 
basis of alcohol abuse or alcoholism; (g) Secs. 523 and 527 of the 
Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), 
as amended, relating to confidentiality of alcohol and drug abuse 
patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 
U.S.C. Sec. 3601 et seq.), as amended, relating to nondiscrimination 
in the sale, rental or financing of housing; (i) any other 
nondiscrimination provisions in the specific statute(s) under which 
application for Federal assistance is being made; and (j) the 
requirements of any other nondiscrimination statute(s) which may 
apply to the application.
    7. Will comply, or has already complied, with the requirements 
of Titles II and III of the Uniform Relocation Assistance and Real 
Property Acquisition Policies Act of 1970 (P.L. 91-646) which 
provide for fair and equitable treatment of persons displaced or 
whose property is acquired as a result of Federal or federally 
assisted programs. These requirements apply to all interests in real 
property acquired for project purposes regardless of Federal 
participation in purchases.
    8. Will comply with the provisions of the Hatch Act (5 U.S.C. 
Secs. 1501-1508 and 7324-7328) which limit the political activities 
of employees whose principal employment activities are funded in 
whole or in part with Federal funds.
    9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40 
U.S.C. Sec. 276c and 18 U.S.C. Secs. 874), and the Contract Work 
Hours and Safety Standards Act (40 U.S.C. Secs. 327-333), regarding 
labor standards for federally assisted construction subagreements.
    10. Will comply, if applicable, with flood insurance purchase 
requirements of Section 102(a) of the Flood Disaster Protection Act 
of 1973 (P.L. 93-234) which requires recipients in a special flood 
hazard area to participate in the program and to purchase flood 
insurance if the total cost of insurable construction and 
acquisition is $10,000 or more.
    11. Will comply with environmental standards which may be 
prescribed pursuant to the following: (a) institution of 
environmental quality control measures under the National 
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order 
(EO) 11514; (b) notification of violating facilities pursuant to EO 
11738; (c) protection of wetlands pursuant to EO 11990; (d) 
evaluation of flood hazards in floodplains in accordance with EO 
11988; (e) assurance of project consistency with the approved State 
management program developed under the Coastal Zone Management Act 
of 1972 (16 U.S.C. Secs. 1451 et seq.); (f) conformity of Federal 
actions to State (Clear Air) Implementation Plans under Section 
176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. Sec. 7401 
et seq.); (g) protection of underground sources of drinking water 
under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523); and (h) protection of endangered species under the Endangered 
Species Act of 1973, as amended, (P.L. 93-205).
    12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 
U.S.C. Secs. 1271 et seq.) related to protecting components or 
potential components of the national wild and scenic rivers system.
    13. Will assist the awarding agency in assuring compliance with 
Section 106 of the National Historic Preservation Act of 1966, as 
amended (16 U.S.C. 470), EO 11593 (identification and protection of 
historic properties), and the Archaeological and Historic 
Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
    14. Will comply with P.L. 93-348 regarding the protection of 
human subjects involved in research, development, and related 
activities supported by this award of assistance.
    15. Will comply with the Laboratory Animal Welfare Act of 1966 
(P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the 
care, handling, and treatment of warm blooded animals held for 
research, teaching, or other activities supported by this award of 
assistance.
    16. Will comply with the Lead-Based Paint Poisoning Prevention 
Act (42 U.S.C. Secs. 4801 et seq.) which prohibits the use of lead 
based paint in construction or rehabilitation of residence 
structures.
    17. Will cause to be performed the required financial and 
compliance audits in accordance with the Single Audit Act of 1984.
    18. Will comply with all applicable requirements of all other 
Federal laws, executive orders, regulations and policies governing 
this program.

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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 belief that it and its principals:
    (a) are not presently debarred, suspended, proposed for debarment, 
declared ineligible, or voluntarily excluded from covered transactions 
by any Federal department or agency;
    (b) have not within a 3-year period preceding this proposal been 
convicted of or had a civil judgment rendered against them for 
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 indicated 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 Transactions'' 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 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

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

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Date

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[FR Doc. 96-22604 Filed 9-4-96; 8:45 am]
BILLING CODE 4184-01-C