[Federal Register Volume 65, Number 53 (Friday, March 17, 2000)]
[Notices]
[Pages 14574-14594]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-6547]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

[Program Announcement No. OCS-2000-07]


Fiscal Year 2000 Family Violence Prevention and Services 
Program--National Domestic Violence Hotline; Availability of Funds and 
Request for Applications

AGENCY: Office of Community Services (OCS), Administration for Children 
and Families (ACF), DHHS.

ACTION: Notice of the availability of funds and request for 
applications to establish and operate the National Domestic Violence 
Hotline.

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SUMMARY: The Administration for Children and Families (ACF), Office of 
Community Services (OCS), announces the availability of funds in fiscal 
year (FY) 2000 for the award of one cooperative agreement on a 
competitive basis to operate a national, toll-free telephone hotline to 
provide information and assistance to victims of domestic violence. 
This announcement contains all of the application materials needed to 
apply for this cooperative agreement.
    The purpose of the national domestic violence hotline is to provide 
information and referral services, counseling, and assistance to 
victims of domestic violence, their children and other family members, 
and others affected by such violence and to enable them to find safety 
and protection in crisis situations. The successful applicant will be 
required to provide telephonic assistance on a 24 hour-per-day, seven 
day-a-week basis throughout the continental United States, and in 
Alaska, Hawaii, the Commonwealth of Puerto Rico, and the Virgin 
Islands.
    Closing Date: The closing date for submission of applications is 
May 17, 2000. Applications postmarked after the closing date will be 
classified as late. Applicants are cautioned to request a legibly dated 
U.S. Postal Service postmark or to obtain a legibly dated receipt from 
a commercial carrier or U.S. Postal Service. Private metered postmarks 
shall not be accepted as proof of timely mailing. Detailed application 
submission instructions, including the addresses where applications 
must be received, are found in Part IV of this announcement.
    Mailing Address: Applications should be mailed to Department of 
Health and Human Services, Administration for Children and Families, 
Office of Grants Management/OCSE, 4th Floor Aerospace Center, 370 
L'Enfant Promenade, SW Washington, DC 20447; Attention: Application for 
Family Violence Prevention and Services Program.
    Number of Copies Required: One signed original application and four 
copies should be submitted at the time of initial submission. (OMB-
0970-0062, expiration date 10/31/2001.)
    Acknowledgment of Receipt: An acknowledgment will be mailed to all 
applicants with an identification number which will be noted on the 
acknowledgment. This number must be referred to in all subsequent 
communications with OCS concerning the application. If an 
acknowledgment is not received within three weeks after the application 
deadline, applicants must notify ACF by telephone (202) 401-5103. 
Applicant should also submit a mailing label for the acknowledgment. 
(Note: To facilitate receipt of this acknowledgment from ACF, applicant 
should include a cover letter with the application containing an E-mail 
address and facsimile (FAX) number if these items are available to 
applicant.)

FOR FURTHER INFORMATION CONTACT: Administration for Children and 
Families, Office of Community Services, Division of State Assistance, 
370 L'Enfant Promenade, SW, Washington, DC 20447. Contact: William 
Riley, (202) 401-5529.
    For a Copy of the Announcement, Contact: Administration for 
Children and Families, Office of Community Services, 370 L'Enfant 
Promenade, SW, 5th Floor West, Washington DC 20447. Telephone: (202) 
401-4787.
    In addition, the announcement will be accessible on the OCS website 
for reading or printing at: http://www.acf.dhhs.gov/programs/ocs under 
``Funding Opportunities''.

SUPPLEMENTARY INFORMATION: This program announcement consists of four 
parts. Part I provides information on the legislative authority 
applicable to this announcement and background information on the 
proposed national domestic violence hotline. Part II describes the 
minimum requirements for the design of the hotline that the applicant 
must address in its

[[Page 14575]]

application. Part III describes the evaluation criteria. Part IV 
provides information and instructions for the development and 
submission of an application.
    The forms to be used for submitting an application follow Part IV. 
Please copy and use these forms in submitting an application under this 
announcement. No additional application materials are available or 
needed to submit an application.
    Applicants should note that the cooperative agreement to be awarded 
under this program announcement is subject to the availability of 
funds.

Part I: General Information

A. Legislative Authority

    Title III of the Child Abuse Amendments of 1984, (Pub. L. 98-457, 
42 U.S.C. 10401, et seq.) is entitled the Family Violence Prevention 
and Services Act (the Act). The Act was first implemented in FY 1986, 
was reauthorized and amended in 1992 by Pub. L. 102-295, and was 
reauthorized and amended for fiscal years 1996 through 2000 by Pub. L. 
103-322, the Violent Crime Control and Law Enforcement Act of 1994 
(Crime Bill), signed into law on September 13, 1994. The Act was most 
recently amended by Pub. L. 104-235, the ``Child Abuse Prevention and 
Treatment Act Amendment of 1996.''
    Section 316 of the Crime Bill, the Violence Against Women Act, 
authorized a grant award for up to five years to provide for the 
operation of a national, toll-free telephone hotline to provide 
information and assistance to victims of domestic violence.

B. Conceptual Framework and Scope of Services

    The prevalence of family violence is widespread and its effective 
prevention and treatment requires coordination and collaboration among 
a broad range of legal, justice system, health, and social service 
providers, and advocates at the Federal, State and local levels.
    To serve the wide range of expected calls effectively, the hotline 
must have expertise about domestic violence and services to victims of 
domestic violence. The staff also must understand the importance of 
using appropriate linkages with State and local resources to serve 
callers to the hotline. The benefits of a highly visible national 
hotline to victims and others will be directly related to the 
productive working relationships and coordinated provision of services 
between and among the hotline and State and local hotlines and other 
services and resources.
    Calls to the hotline may range from the urgent and life-threatening 
to calls for general reference information. The target population to be 
served by the hotline is specified in the statute as ``victims of 
domestic violence''. The hotline should be prepared to respond to the 
broad range of violence that occurs in the context of family and 
intimate relationships, domestic violence, spouse abuse, partner abuse, 
battering of women, sexual assault, date rape, and acquaintance rape. 
The hotline also will serve those less directly affected by such abuse, 
e.g., relatives, children of victims and other family members, friends, 
neighbors, perpetrators and batterers, other concerned individuals, and 
the general public.
    In terms of the scope of the services provided by the hotline, the 
statute requires the provision of ``information and assistance'' and 
``counseling and referral services''. Therefore, the applicants' 
proposed design and plan for operating the hotline and responding to 
callers is important. However, the hotline is not expected to provide 
extended or long-term counseling or therapy services. The fuller 
discussion of a problem and consideration of options is done most 
appropriately at the local level, given the variation in laws and 
services available among the States and localities.
    Because domestic violence often contributes to isolation, 
helplessness, loss of self-esteem, and dependence, a self-help and 
empowerment model of services is needed. Such a model:
     Protects and assures safety for all victims and other 
family members;
     Builds on the strengths and resources of individuals and 
families;
     Offers options and support for independent decision-making 
based on specific individual and family needs and circumstances; and
     Assists individuals and families to obtain protection and 
needed services that are respectful of cultural and community 
characteristics.
    Finally, we recognize that there is an inter-relationship between 
alcohol, drug abuse, and mental health (ADM) problems and domestic 
violence. Alcohol abuse has been demonstrated to contribute to violent 
behavior. Moreover, the abuse of alcohol coupled with other drugs is 
even more likely to be associated with severe battering incidents than 
is alcohol by itself. Victims of and or witnesses to domestic violence 
also may experience psychological consequences or turn to substance 
abuse to ameliorate their pain. In addition to the physical trauma 
resulting from acts of physical abuse, battered women suffer from a 
number of mental health consequences, including higher levels of 
depression, drug and alcohol abuse, suicide attempts, and low self-
esteem. Many of the mental health consequences of spousal violence 
result from chronic intimidation and fear, which are often as 
significant as the actual, acts of physical aggression. Witnessing 
spousal violence contributes to the cycle of violence outside the home. 
There is an increased likelihood of child abuse in homes where there 
has already been spouse abuse.

C. Eligible Applicants

    Any private nonprofit agency, organization, institution, Tribal 
organization, or combination thereof, is eligible to apply for these 
funds. The applicant nonprofit entity must submit documentation of its 
experience and capability to operate a 24 hour, 365 days a year, 
domestic violence hotline. Any nonprofit organization submitting an 
application must also submit proof of its nonprofit status in its 
application at the time of submission. Proof of nonprofit status can be 
accomplished by providing a copy of the applicant's listing in the 
Internal Revenue Service's (IRS) most recent list of tax-exempt 
organizations described in Section 501(c)(3) of the IRS Code, or by 
providing a copy of the currently valid IRS tax exemption certificate, 
or by providing a copy of the articles of incorporation bearing the 
seal of the State in which the corporation or association is domiciled.

D. Availability of Funds

    As authorized by section 316 of the Act, the Office of Community 
Services will award one cooperative agreement in FY 2000 for a maximum 
of $1,957,000 for the implementation of the toll-free rational domestic 
violence hotline. The source of these funds will be the Crime Bill 
Trust Fund.
    Non-competitive continuation grant awards for each of years two 
through five (FYs 2001-2004) are projected to be $2,000,000 per fiscal 
year subject to the availability of funds.

E. Duration of Project

    The Office of Community Services will award one grant, as a 
cooperative agreement, for up to five years (60-month project period). 
The initial grant award will cover a 12-month budget period. 
Application for continuation funding beyond the initial 12-month budget 
period, but within the 60-month project period, will be considered in 
subsequent years on a non-competitive basis, subject to the approval of 
the Secretary, the availability of funds, the

[[Page 14576]]

satisfactory performance of the grantee, and the determination that the 
continued funding and support of the project would be in the best 
interest of the government.

F. Cooperative Agreement

    The Office of Community Services intends to support the national 
toll-free hotline through a cooperative agreement. A cooperative 
agreement is Federal financial aid in which substantial Federal 
involvement is anticipated. The responsibilities of the Administration 
for Children and Families and of the successful applicant will be 
identified and incorporated into the cooperative agreement during pre-
award negotiations. It is anticipated that ACF responsibilities will 
not change the project requirements found in Part II of this 
announcement.
    The grantee will outline a plan of interaction with OCS for 
implementation under a cooperative agreement including, as appropriate, 
activities involving Federal staff. The plan under the cooperative 
agreement will describe the general and specific responsibilities of 
the grantee and the grantor as well as foreseeable joint 
responsibilities. A schedule of tasks will be developed and agreed upon 
in addition to any special conditions relating to the implementation of 
the hotline.

Part II: Project Requirements

Requirements for Project Implementation

    The following requirements must be met by the grantee and addressed 
in the application:
    1. All funds received by the grantee pursuant to Section 316 of the 
Act must be used to establish and operate a national toll-free, 
telephone hotline to provide information and assistance to victims of 
domestic violence.
    2. In establishing the hotline, the private, nonprofit entity 
shall:
     Contract with a carrier for the use of a toll-free 
telephone line;
     Employ, train, and supervise personnel to answer incoming 
calls and provide counseling and referral services on a 24-hour-a-day 
basis;
     Assemble and maintain a current database of information 
relating to services for victims of domestic violence to which callers 
may be referred throughout the United States, including information on 
the availability of shelters that serve battered women and their 
children; and
     Publicize the hotline to potential users throughout the 
United States.
    3. To be approved by the Secretary, the application must include a 
complete description of the applicant's plan for the operation of a 
national domestic violence hotline, including description of:
     The training program for hotline personnel;
     The hiring criteria for hotline personnel;
     The methods for the creation, maintenance, and updating of 
a resource database;
     A plan for publicizing the availability of the hotline;
     A plan for providing service to non-English speaking 
callers, including hotline personnel who speak Spanish; and
     A plan for facilitating access to the hotline by persons 
with hearing impairments.
    4. The applicant must demonstrate that it has:
      Nationally recognized expertise in the operation of a 
domestic violence hotline and a record of high quality service to 
victims of domestic violence, including a demonstration of support from 
advocacy groups, such as domestic violence State coalitions or 
recognized national domestic violence groups; and
     A commitment to diversity, and to the provision of 
services to ethnic, racial, and non-English speaking minorities, in 
addition to older individuals and individuals with disabilities.
    5. The applicant must demonstrate knowledge of the field, including 
the range of services and the resources available for domestic violence 
victims, their children and family members, perpetrators and batterers, 
and other concerned individuals, including services and resources 
relating to substance and mental health problems; State and Indian 
tribal domestic violence laws, including the availability of legal 
protection; and the barriers affecting access to such services, 
resources and protection.
    6. The applicant must demonstrate experience in providing high-
quality crisis intervention, information and referral, and counseling 
services and support to battered women, their children, other domestic 
violence victims, their family and friends, batterers, and the general 
public through a national toll-free hotline.
    7. The applicant must demonstrate an understanding of the 
relationship of alcohol, drug abuse, and mental health problems to 
incidents of domestic violence and the ability to make appropriate 
referrals to callers.
    8. The applicant must demonstrate an understanding of the need for 
a national hotline for domestic violence victims, including a 
description of the function and limitation of the current network of 
national and State crisis hotlines, information lines, and State 
victims' referral services.
    9. The applicant must provide a plan and demonstrated ability to 
build, maintain, and keep current a comprehensive database of resource 
information, including the full range of services available in local 
communities, the types of legal protection and services available in 
different States and localities, and the capability to access 
information.
    10. The applicant must provide a detailed description of:
     The telecommunications and computer technology that is or 
will be employed to establish and support the hotline, including all 
management functions, referral functions, resource database management 
functions, monitoring functions, and overall project administration and 
quality control, including periodic reporting to HHS;
     The design and operation of the telephone system that will 
be used to provide the service; its capacity and its limitations, 
including information such as the capacity to facilitate the number of 
incoming calls, call conferencing, automatic call referral to local 
providers, and service integration with computers;
     The methods that will be used to ensure that the national 
hotline is a confidential crisis intervention and the specific 
provisions that will be in place to safeguard the confidentiality of 
callers and ensure the proper handling of confidential or sensitive 
information;
     The personnel recruitment, hiring, and training program 
(i.e., a description of an initial and ongoing training plan for staff 
and volunteers should be included in this section) that will ensure the 
delivery of quality crisis intervention, information and referral, 
assistance, and counseling services to diverse populations;
     The specific emergency response and crisis protocol to be 
used, the ability to conference call (or ``patch'') a caller to a local 
domestic violence, legal services, or mental health or substance abuse 
program when appropriate, and the plans for minimizing such problems as 
crank/obscene calls and busy signals; and
     The methods the applicant will use to provide for the 
development, maintenance, and updating of a comprehensive resource 
database (distributed to the maximum extent appropriate); the technical 
capacity to link with other State and local databases in order to 
maintain an extensive and current resource locator or listing; the

[[Page 14577]]

ability to facilitate communication among service providers to assist 
the provision of services; and how the information on best practices 
gathered through various inventories will be used to assist victims of 
family violence.
    11. The applicant must demonstrate an understanding of the 
technological requirements of such a project and include a detailed 
timeline to provide the following services nationally:
     24-hour/365 days per year access;
     Direct access to English and Spanish-speaking personnel at 
all times and provision for services to other non-English speaking 
callers and the hearing impaired;
      Personnel (paid staff and volunteers) trained in crisis 
intervention, information and referral, and counseling skills;
     Comprehensive database of current information;
     The ability to connect callers directly to local programs 
or services when appropriate;
     Emergency response protocol for callers in immediate 
danger; and
     Appropriate confidentiality safeguards; and data 
collection and data management capability sufficient to support program 
administration, reporting, monitoring, and an ongoing quality 
assessment of the hotline service.
    12. The applicant must provide a plan to coordinate, work with, and 
provide hotline services and data resource and referrals that make 
maximum use of existing domestic violence programs and resources, 
including, but not limited to, local and State-wide domestic violence 
hotlines, State Domestic Violence Coalitions, State Sexual Assault 
Coalitions, shelter programs, emergency services, legal services 
programs, national domestic violence resource centers, other existing 
national hotlines, and other national organizations; resources related 
to child abuse and youth endangerment, ADM problems, and perpetrators 
and batterers programs. The applicant must provide support to State and 
local domestic violence hotlines in response to demands generated by 
the national public awareness campaign.
    13. The applicant must provide a description of the quality 
assurance system it will use to assess regularly the quality of the 
services being provided by the hotline and the extent to which the 
goals and objectives of the service are being met. The quality 
assurance system also must include actions to address identified 
problems.
    14. The applicant must provide a comprehensive plan to publicize 
the hotline to a national audience, including efforts to ensure 
promotion through the national media and through targeted outreach to 
racially and ethnically diverse communities, older individuals, and 
individuals with disabilities.
    15. The applicant must demonstrate the ability to staff, 
financially support, and programmatically administer a national project 
of this scope.
    16. The author(s) of the application must be clearly identified 
together with a description of his or her current relationship to the 
applicant organization and any future project role he or she may have 
if the project is funded.
    17. The applicant must provide an assurance that any information 
collected as a part of this grant will become the property of the 
Federal Government.
    18. The applicant must provide an assurance that it will work with 
the Federal Project Officer to identify the information that will be 
compiled based on incoming calls including compilation of information 
on both maternal and child victims of domestic violence and individual 
and situational factors characterizing violent and abusive behavior.
    19. The applicant must provide an assurance that it will comply 
with the grant administration requirements in 45 CFR part 74.

Part III: Evaluation Criteria

    The five criteria that follow will be used to review and evaluate 
how each applicant has addressed the requirements stated in Part II and 
should be used in developing the program narrative. The point values 
following each criterion heading indicate the maximum numerical weight 
that each section will be given in the review process.

1. Need for the Project (10 Points)

    Provide a detailed discussion of the need for a national domestic 
violence hotline of the scope being proposed. Provide a detailed 
analysis of the available data related to the problem being addressed 
(both domestic violence in general and the specific lack of a national 
domestic violence hotline); the strengths and limitations of other 
national and local crisis intervention and victim services hotline/
referral services available, and the ``state-of-the-art'' relative to 
the problem being addressed by the proposal.

2. Goals and Objectives (10 Points)

    Clearly state the project goals and objectives. Objectives should 
be stated in concrete, measurable terms which clearly identify the 
population(s) to be served, the type, quality, and level of service to 
be provided, the timeline for the establishment and delivery of 
services, and other project benchmarks. The anticipated demand for 
hotline services during the initial start-up period and a projection of 
the demand on an ongoing basis should be discussed, with supporting 
documentation. Describe the precise location of the project.

3. Approach (30 Points)

    Provide a sound workable plan of action (approach) which details: 
How the proposed work will be accomplished; how each task relates to 
the project's goals and activities; identifies the key staff member 
responsible for the specific tasks; provides a chart indicating the 
timetable for completing each task, the phasing in of the tasks over 
time, the lead staff person, and the time committed to the task; cites 
factors which might accelerate or decelerate the work; justifies the 
approach selected over other approaches; makes maximum use of existing 
facilities and resources and off-the-shelf technology; describes and 
supports any unusual features of the project, such as design or 
technological innovations, reductions in cost or time, or extraordinary 
social or community involvement; and provides projections of the 
accomplishments to be achieved and identifies the activities for which 
Federal technical assistance, advice, or guidance as the project is 
implemented is anticipated and would be acceptable.

4. Results and Benefits Expected (20 Points)

    Identify, in specific terms, the results and benefits to be derived 
from the project and relate each result and benefit to a specific 
objective. Indicate the aggregate number of calls expected to be 
received and individuals to be assisted on an annual basis, e.g., the 
expected volume of calls in such service areas as crisis counseling, 
immediate referrals to shelters, or the number of referrals made in 
response to non-English speaking callers. Indicate the anticipated 
impact on and the subsequent benefit of the national hotline to victims 
of domestic violence and on the existing network of State and local 
shelters and services. Identify the kinds of data to be collected, 
maintained, and updated, and discuss the criteria to be used to assure 
the quality of the services provided.

5. Level of Effort (30 Points)

    Expertise, Commitment, and Support. The extent to which the 
applicant has nationally recognized expertise in the

[[Page 14578]]

area of domestic violence and a record of high quality service to 
victims of domestic violence, including a demonstration of support from 
advocacy groups, such as State Domestic Violence Coalitions or 
recognized national domestic violence groups; the extent of the 
applicant's commitment to diversity, and to the provision of service to 
ethnic, racial, and non-English speaking minorities, older individuals, 
and individuals with disabilities.
    Staff Background and Organizational Experience. The adequacy of the 
staffing pattern for the proposed project, how the individual 
responsibilities are linked to project tasks, and the contributions to 
be made by key staff. Each collaborating or cooperative organization, 
individual consultant, or other key individuals who will work on the 
project should be listed along with a description of the nature of 
their effort or contribution.
    Competence of Staff. The background and experience of the project 
director and key project staff and the history and accomplishments of 
the organization; the qualifications of the project team including any 
experience with similar projects; the variety of skills, relevant 
educational background, and the ability to effectively manage the 
project and to coordinate activities with other agencies. One or two 
pertinent paragraphs on each key member are preferred to vitae/resumes. 
However, vitae/resumes may be included.
    Adequacy of Resources. The adequacy of the available resources and 
organizational experience with regard to the tasks of the proposed 
project. List the financial, physical, and other resources already 
committed by other public and private agencies and institutions, if 
any. Explain how these organizations will participate in the day to day 
operations of the project. Letters from these agencies and 
organizations identifying and discussing the specifics of their 
commitment and participation must be included in the application.
    Budget. Relate the proposed budget to the level of effort required 
to obtain the project objectives. Demonstrate that the project's costs 
are reasonable in view of the anticipated results.
    Collaborative Efforts. The additional anticipated private sector 
resources that may be available to support or enhance the overall 
program. Discuss in detail and provide documentation for any proposed 
collaborative or coordinated efforts with other public and private 
agencies or organizations. Identify these agencies or organizations and 
explain how their participation will enhance the project. Letters from 
these agencies and organizations must be included discussing their 
interest and/or commitment in supporting this project, the stage of the 
planning and decision-making, and the expected level of resource 
commitment.

Part IV: Other Information and Instructions for the Development and 
Submission of Applications

A. Required Notification of the State Single Point of Contact

    This program is covered under Executive Order 12372, (E.O.) 
``Intergovernmental Review of Federal Programs,'' and 45 CFR part 100, 
``Intergovernmental Review of Department of Health and Human Services 
Program and Activities.'' Under the E.O., States may design their own 
processes for reviewing and commenting on proposed Federal assistance 
under covered programs.
    All States and territories, except Alabama, Alaska, Colorado, 
Connecticut, Hawaii, Idaho, Kansas, Louisiana, Massachusetts, 
Minnesota, Montana, Nebraska, New Jersey, Oklahoma, Oregon, 
Pennsylvania, South Dakota, Tennessee, Vermont, Virginia, Washington, 
American Samoa and Palau, have elected to participate in the E.O. 
process and have established a Single Point of Contact (SPOCs). 
Applicants from these twenty-three 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 OCS can 
obtain and review SPOC comments as part of the award process. It is 
imperative that the applicant submit all required materials, if any, to 
the SPOC and indicate the date of this submittal (or the date of 
contact if no submittal is required) on the Standard Form 424, item 
16a.
    Under 45 CFR 100.8(a)(2), a SPOC has 60 days from application 
deadline to comment on proposed new or competing continuation awards.
    SPOCs are encouraged to eliminate the submission of routine 
endorsements as official recommendations. Additionally, SPOCs are 
requested to differentiate clearly between mere advisory comments and 
those official State process recommendations that 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 Office of Grants Management/OCSE, 4th Floor 
Aerospace Center, 370 L'Enfant Promenade, SW, Washington, DC 20447.
    A list of the Single Point of Contact for each State and Territory 
is included at the end of this announcement.

B. Paperwork Reduction Act of 1995

    Under the Paperwork Reduction Act of 1995, Public Law 104-13, the 
Department is required to submit to the Office of Management and Budget 
(OMB) for review and approval any reporting and recordkeeping 
requirements in regulations, including program announcements. This 
program announcement does not contain information requirements beyond 
those approved for ACF grant applications under OMB Control Number 
0970-0062, expiration date 10/31/2001. An agency may not conduct or 
sponsor and a person is not required to respond to a collection of 
information unless it displays a currently valid OMB control number.

C. Application Submission

    The closing date and time for submittal of applications under this 
program announcement is found at the beginning of this program 
announcement under ``Closing Date''. Applications postmarked after the 
closing date will be classified as late.
    Deadline: Mailed applications shall be considered as meeting an 
announced deadline if they are either received on or before the 
deadline date or sent on or before the deadline date and received by 
ACF in time for the independent review to: U.S. Department of Health 
and Human Services, Administration for Children and Families, Office of 
Grants Management/OCSE, 4th Floor West, Aerospace Center, 370 L'Enfant 
Promenade, SW., Washington, DC 20447; Attention: Application for Family 
Violence Prevention and Services Program.
    Applicants are cautioned to request a legibly dated U.S. Postal 
Service postmark or to obtain a legibly dated receipt from a commercial 
carrier or U.S. Postal Service. Private Metered postmarks shall not be 
acceptable as proof of timely mailing.
    Applications handcarried by applicants, applicant couriers, or by 
overnight/express mail couriers shall be considered as meeting an 
announced deadline if they are received on or before the deadline date, 
between the hours of 8:00 a.m. and 4:30 p.m., EST,

[[Page 14579]]

and at the U.S. Department of Health and Human Services, Administration 
for Children and Families, Office of Grants Management/OCSE, ACF 
Mailroom, 2nd Floor Loading Dock, Aerospace Center, 901 D Street, SW, 
Washington, DC 20024, between Monday and Friday (excluding Federal 
holidays). The address must appear on the envelope/package containing 
the application with the note: Attention: Application for Family 
Violence Prevention and Services Program. (Applicants are again 
cautioned that express/overnight mail services do not always deliver as 
agreed.)
    ACF cannot accommodate transmission of applications by fax or 
through other electronic media. Therefore, applications transmitted to 
ACF electronically will not be accepted regardless of date or time of 
submission and time of receipt.
    Late Applications: Applications which do not meet the criteria 
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 and hurricanes, or 
when there is widespread disruption of the mails. A determination to 
waive or extend deadline requirements rests with the Chief Grants 
Management Officer.

D. Instructions for Preparing the Application and Completing 
Application Forms

1. SF 424
    The SF 424 and certifications have been reprinted for your 
convenience in preparing the application. You should reproduce single-
sided copies of these forms from the reprinted forms in the 
announcement, typing your information onto the copies.
    At the top of the Cover Page of the SF 424, enter the single 
priority area number under which the application is being submitted. An 
application should be submitted under only one priority area.
2. SF 424A--Budget Information--Non-Construction Programs
    With respect to the 424A, Budget Information--Non-Construction 
Programs, Sections A, B, C, E, and F are to be completed. Section D 
does not need to be completed.
    In order to assist applicants in correctly completing the SF 424 
and 424A, detailed instructions for completing these forms are 
contained on the forms themselves. See the Instructions accompanying 
the attached SF 424A, as well as the instructions set forth below.

Section A--Budget Summary

Lines 1-4
    Column (a) Line 1--Enter OCS FVPS Program.
    Column (b) Line 1--Enter 93.592.
    Columns (c) and (d)--Not Applicable.
    Columns (e), (f) and (g)--For lines 1 through 4, enter in 
appropriate amounts needed to support the project for the entire 
project period.
Line 5
    Enter the figures from Line 1 for all columns completed, (e), (f), 
and (g).

Section B--Budget Categories

    This section should contain entries for OCS funds only. For all 
projects, the first budget period will be entered in Column (1).
    Allocability of costs is governed by applicable cost principles set 
forth in the Code of Federal Regulations (CFR), Title 45, Parts 74 and 
92.
    Budget estimates for administrative costs must be supported by 
adequate detail for the grants officer to perform a cost analysis and 
review. Adequately detailed calculations for each budget object class 
are those which reflect estimation methods, quantities, unit costs, 
salaries, and other similar quantitative detail sufficient for the 
calculation to be duplicated. For any additional object class 
categories included under the object class other, identify the 
additional object class(es) and provide supporting calculations.
    Supporting narratives and justifications are required for each 
budget category, with emphasis on unique/special initiatives; large 
dollar amounts; local, regional, or other travel; new positions; major 
equipment purchases; and training programs.
    A detailed itemized budget with a separate budget justification for 
each major item should be included as indicated below:
Line 6a
    Personnel--Enter the total costs of salaries and wages.
    Justification--Identify the project director and staff. Specify by 
title or name the percentage of time allocated to the project, the 
individual annual salaries and the cost to the project (both Federal 
and non-Federal) of the organization's staff who will be working on the 
project.
Line 6b
    Fringe Benefits--Enter the total costs of fringe benefits unless 
treated as part of an approved indirect cost rate which is entered on 
Line 6j.
    Justification--Enter the total costs of fringe benefits, unless 
treated as part of an approved indirect cost rate. Provide a breakdown 
of amounts and percentages that comprise fringe benefit costs.
Line 6c
    Travel--Enter total cost of all travel by employees of the project. 
Do not enter costs for consultant's travel.
    Justification--Include the name(s) of traveler(s), total number of 
trips, destinations, length of stay, mileage rate, transportation costs 
and subsistence allowances. Traveler must be a person listed under the 
personnel line or employee being paid under non-federal share. (Note: 
Local transportation and Consultant travel costs are entered on Line 
6h.)
Line 6d
    Equipment--Enter the total costs of all equipment to be acquired by 
the project. Equipment means an article of nonexpendable, tangible 
personal property having a useful life of more than one year and an 
acquisition cost which equals or exceeds the lesser of (a) the 
capitalization level established by the organization for financial 
statement purposes, or (b) $5,000. (Note: If an applicant's current 
rate agreement was based on another definition for equipment, such as 
``tangible personal property $500 or more'', the applicant shall use 
the definition used by the cognizant agency in determining the rate(s). 
However, consistent with the applicant's equipment policy, lower limits 
may be set.)
    Justification--Equipment to be purchased with Federal funds must be 
required to conduct the project, and the applicant organization or its 
subgrantees must not already have the equipment or a reasonable 
facsimile available to the project.
Line 6e
    Supplies--Enter the total costs of all tangible personal property 
other than that included on line 6d.
    Justification--Provide a general description of what is being 
purchased such as type of supplies: office, classroom, medical, etc. 
Include equipment costing less than $5,000 per item.
Line 6f
    Contractual--Enter the total costs of all contracts, including (1) 
procurement contracts (except those which belong on other lines such as 
equipment, supplies, etc.) and (2) contracts with secondary

[[Page 14580]]

recipient organizations including delegate agencies and specific 
project(s) or businesses to be financed by the applicant.
    Justification--Attach a list of contractors, indicating the names 
of the organizations, the purposes of the contracts, the estimated 
dollar amounts, and selection process of the awards as part of the 
budget justification. Also provide back-up documentation identifying 
the name of contractor, purpose of contract, and major cost elements.

    Note 1: Whenever the applicant/grantee intends to delegate part 
of the program to another agency, the applicant/grantee must submit 
Sections A and B of this Form SF-424A, completed for each delegate 
agency by agency title, along with the required supporting 
information referenced in the applicable instructions. The total 
costs of all such agencies will be part of the amount shown on Line 
6f. Provide draft Request for Proposal in accordance with 45 CFR 
part 74, appendix A. All procurement transactions shall be conducted 
in a manner to provide, to the maximum extent practical, open and 
free competition.


    Note 2: Contractual cannot be a person--must be an organization, 
firm, etc. Enter Consultant cost on Line 6h.

Line 6g
    Construction--Not applicable.
Line 6h
    Other--Enter the total of all other costs. Such costs, where 
applicable, may include, but are not limited to, insurance, food, 
medical and dental costs (non-contractual), fees and travel paid 
directly to individual consultants, local transportation (all travel 
which does not require per diem is considered local travel), space and 
equipment rentals, printing and publication, computer use training 
costs including tuition and stipends, training service costs including 
wage payments to individuals and supportive service payments, and staff 
development costs.
Line 6j
    Indirect Charges--Enter the total amount of indirect costs. This 
line should be used only when the applicant currently has an indirect 
cost rate approved by DHHS or other Federal agencies.
Line 6k
    Totals--Enter the total amount of Lines 6i and 6j.
Line 7
    Program Income--Enter the estimated amount of income, if any, 
expected to be generated from this project. Separately show expected 
program income generated from OCS support and income generated from 
other mobilized funds. Do not add or subtract this amount from the 
budget total. Show the nature and source of income in the program 
narrative statement.
    Justification--Describe the nature, source and anticipated use of 
program income in the Program Narrative Statement.

Section C--Non-Federal Resources

    This section is to record the amounts of Non-Federal resources that 
will be used to support the project. Non-Federal resources mean other 
than OCS funds for which the applicant has received a commitment. 
Provide a brief explanation, on a separate sheet, showing the type of 
contribution, broken out by Object Class Category, (See SF-424A, 
Section B.6) and whether it is cash or third party in-kind. The firm 
commitment of these required funds must be documented and submitted 
with the application in order to be given credit in the Criterion.
    Except in unusual situations, this documentation must be in the 
form of letters of commitment or letters of intent from the 
organization(s)/individuals from which funds will be received.
Line 8
    Column (a)--Enter the project title.
    Column (b)--Enter the amount of cash or donations to be made by the 
applicant.
    Column (c)--Enter the State contribution.
    Column (d)--Enter the amount of cash and third party in-kind 
contributions to be made from all other sources.
    Column (e)--Enter the total of columns (b), (c), and (d).
Lines 9, 10 and 11
    Leave Blank.
Line 12
    Carry the total of each column of Line 8, (b) through (e). The 
amount in Column (e) should be equal to the amount on Section A, Line 
5, Column (f).
    Justification--Describe third party in-kind contributions, if 
included.

Section F--Other Budget Information

Line 21
    Direct Charges--Include narrative justification required under 
Section B for each object class category for the total project period.
Line 22
    Indirect Charges--Enter the type of DHHS or other Federal agency 
approved indirect cost rate (provisional, predetermined, final or 
fixed) that will be in effect during the funding period, the estimated 
amount of the base to which the rate is applied and the total indirect 
expense. Also, enter the date the rate was approved, where applicable. 
Attach a copy of the approved rate agreement.
Line 23
    Provide any other explanations and continuation sheets required or 
deemed necessary to justify or explain the budget information.
3. Project Summary Description
    Clearly mark this separate page with the applicant name as shown in 
item 5 of the SF 424, and the title of the project as shown in item 11 
of the SF 424. The summary description should not exceed 300 words. 
These 300 words become part of the computer database on each project.
    Care should be taken to produce a summary description which 
accurately and concisely reflects the application. It should describe 
the objectives of the project, the approaches to be used and the 
outcomes expected. The description should also include a list of major 
products that will result from the proposed project, such as software 
packages, materials, management procedures, data collection 
instruments, training packages, or videos (please note that 
audiovisuals should be closed captioned). The project summary 
description, together with the information on the SF 424, will 
constitute the project ``abstract.'' It is the major source of 
information about the proposed project and is usually the first part of 
the application that the reviewers read in evaluating the application.
4. Program Narrative Statement
    The Program Narrative Statement is a very important part of an 
application. It should be clear, concise, and address the specific 
requirements mentioned under the priority area description in Part II. 
The narrative should also provide information concerning how the 
application meets the evaluation criteria using the following headings:
    (a) Need for the Project;
    (b) Goals and Objectives;
    (c) Approach;
    (d) Results and Benefits; and
    (e) Level of effort.
    The specific information to be included under each of these 
headings is described in Part III, Evaluation Criteria.
    The narrative should be typed double-spaced on a single-side of an 
8\1/2\" x 11" plain white paper, with 1" margins on

[[Page 14581]]

all sides. All pages of the narrative (including charts, references/
footnotes, tables, maps, exhibits, etc.) must be sequentially numbered, 
beginning with ``Objectives and Need for the Project'' as page number 
one. Applicants should not submit reproductions of larger size paper, 
reduced to meet the size requirement.
    The length of the application, including the application forms and 
all attachments, should not exceed 60 pages. A page is a single side of 
an 8\1/2\" x 11" sheet of paper. Applicants are requested not to send 
pamphlets, maps, brochures or other printed material along with their 
application as these pose photocopy difficulties. These materials, if 
submitted, will not be included in the review process if they exceed 
the 60-page limit. Each page of the application will be counted to 
determine the total length.
5. Organizational Capability Statement
    The Organizational Capability Statement should consist of a brief 
(two to three pages) background description of how the applicant 
organization (or the unit within the organization that will have 
responsibility for the project) is organized, the types and quantity of 
services it provides, and/or the research and management capabilities 
it possesses. This description should cover capabilities not included 
in the Program Narrative Statement. It may include descriptions of any 
current or previous relevant experience, or describe the competence of 
the project team and its demonstrated ability to produce a final 
product that is readily comprehensible and usable. An organization 
chart showing the relationship of the project to the current 
organization should be included.
6. Assurances/Certifications
    Applicants are required to file an SF 424B, Assurances--Non-
Construction Programs, and the Certification Regarding Lobbying. Both 
must be signed and returned with the application. In addition, 
applicants must certify their compliance with: (1) Drug-Free Workplace 
Requirements; and (2) Debarment and Other Responsibilities; and (3) 
Certification Regarding Environmental Tobacco Smoke. These 
certifications are self-explanatory. Copies of these assurances/
certifications are reprinted at the end of this Application Kit and 
should be reproduced as necessary. A duly authorized representative of 
the applicant organization must certify that the applicant is in 
compliance with these assurances/certifications. A signature on the SF 
424 indicates compliance with the Drug Free Workplace Requirements, and 
Debarment and Other Responsibilities, and Environmental Tobacco Smoke 
certifications.

E. The Application Package

    Each application package must include an original and four copies 
of the complete application. Each copy should be stapled securely 
(front and back if necessary) in the upper left-hand corner. All pages 
of the narrative (including charts, tables, maps, exhibits, etc.) must 
be sequentially numbered, beginning with page one. In order to 
facilitate handling, please do not use covers, binders or tabs. Do not 
include extraneous materials as attachments, such as agency promotion 
brochures, slides, tapes, film clips, minutes of meetings, survey 
instruments or articles of incorporation.
    Applicants should include a self-addressed stamped acknowledgment 
card. All applicants will be notified automatically about the receipt 
of their application. If acknowledgment of receipt of your application 
is not received within three weeks after the deadline date, please 
notify ACF by telephone at (202) 401-5103.

F. Post-Award Information and Reporting Requirements

    Following approval of the applications selected for funding, notice 
of project approval and authority to draw down project funds will be 
made in writing. The official award document is the Financial 
Assistance Award which provides the amount of Federal funds approved 
for use in the project, the project and budget periods for which 
support is provided, the terms and conditions of the award, the total 
project period for which support is contemplated, and the total 
required financial grantee participation.
    General Conditions and Special Conditions (where the latter are 
warranted) which will be applicable to grants, grantees will be subject 
to the provisions of 45 CFR part 74 or 92.
    Grantees will be required to submit quarterly progress and semi-
annual financial reports (SF 269) throughout the project period, as 
well as a final progress and financial report within 90 days of the 
termination of the project.
    Grantees are subject to the audit requirements in 45 CFR parts 74 
(non-governmental), 92 (governmental), OMB Circular A-133 and OMB 
Circular A-128. If an applicant does not request indirect costs, it 
should anticipate in its budget request the cost of having an audit 
performed at the end of the grant period.
    Section 319 of Public Law 101-121, signed into law on October 23, 
1989, imposes prohibitions and requirements for disclosure and 
certification related to lobbying on recipients of Federal contracts, 
grants, cooperative agreements, and loans. It provides exemptions for 
Indian Tribes and Tribal organizations. Current and prospective 
recipients (and their subtier contractors and/or grantees) are 
prohibited from using Federal funds, other than profits from a Federal 
contract, for lobbying Congress or any Federal agency in connection 
with the award of a contract, grant, cooperative agreement or loan. In 
addition, for each award action in excess of $100,000 (or $150,000 for 
loans) the law requires recipients and their subtier contractors and/or 
subgrantees (1) To certify that they have neither used nor will use any 
appropriated funds for payment to lobbyists; (2) to disclose the name, 
address, payment details, and the purpose of any agreements with 
lobbyists whom recipients or their subtier contractors or subgrantees 
will pay with profits or nonappropriated funds on or after December 22, 
1989 and (3) to file quarterly up-dates about the use of lobbyists if 
material changes occur in their use. The law establishes civil 
penalties for noncompliance.

(Catalog of Federal Domestic Assistance number 93.592, Family 
Violence Prevention and Services)
    Dated: March 9, 2000.
Donald Sykes,
Director, Office of Community Services.

Family Violence Prevention and Services Program; List of 
Attachments

Attachment B-1 Application for Federal Assistance
Attachment B-2 Budget Information--Non Construction Programs
Attachment B-3 Assurances--Non Construction Programs
Attachment C Certification Regarding Drug Free Requirements
Attachment D Certification Regarding Debarment, Suspension
Attachment E Certification Regarding Environmental Tobacco Smoke
Attachment F-1 Certification Regarding Lobbying
Attachment F-2 Disclosure of Lobbying Activities
Attachment G State Single Point of Contact Listing

BILLING CODE 4184-01-P

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BILLING CODE 4184-01-C

[[Page 14583]]

Instructions for the SF-424

    Public reporting burden for this collection of information is 
estimated to average 45 minutes per response, including time for 
reviewing instructions, searching existing data sources, gathering 
and maintaining the data needed, and completing and reviewing the 
collection of information. Send comments regarding the burden 
estimate or any other aspect of this collection of information, 
including suggestions for reducing this burden, to the Office of 
Management and Budget, Paperwork Reduction Project (0348-0043), 
Washington, DC 20503.
    Please do not return your completed form to the Office of 
Management and Budget. Send it to the address provided by the 
sponsoring agency.
    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) and applicant's control number (if applicable).
    3. State use only (if applicable).
    4. If this application is to continue or revise an existing 
award, enter present Federal identifier number. If for a new 
project, leave blank.
    5. Legal name of applicant, name of primary organizational unit 
which will undertake the assistance activity, complete address of 
the applicant, and name and telephone number of the person to 
contact on matters related to this application.
    6. Enter Employer Identification Number (EIN) as assigned by the 
Internal Revenue Service.
    7. Enter the appropriate letter in the space provided.
    8. Check appropriate box and enter appropriate letter(s) in the 
space(s) provided:

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

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

BILLING CODE 4184-01-M

[[Page 14584]]

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[[Page 14585]]


[GRAPHIC] [TIFF OMITTED] TN17MR00.002


BILLING CODE 4184-01-C

[[Page 14586]]

Instructions for the SF-424A

    Public reporting burden for this collection of information is 
estimated to average 180 minutes per response, including time for 
reviewing instructions, searching existing data sources, gathering 
and maintaining the data needed, and completing and reviewing the 
collection of information. Send comments regarding the burden 
estimate or any other aspect of this collection of information, 
including suggestions for reducing this burden, to the Office of 
Management and Budget, Paperwork Reduction Project (0348-0044), 
Washington, DC 20503.
    Please do not return your completed form to the Office of 
Management and Budget. Send it to the address provided by the 
sponsoring agency.

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 
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 Column (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 Column (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.

Line 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 thisproject. 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.

[[Page 14587]]

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

    Public reporting burden for this collection of information is 
estimated to average 15 minutes per response, including time for 
reviewing instructions, searching existing data sources, gathering 
and maintaining the data needed, and completing and reviewing the 
collection of information. Send comments regarding the burden 
estimate or any other aspect of this collection of information, 
including suggestions for reducing this burden, to the Office of 
Management and Budget, Paperwork Reduction Project (0348-0040), 
Washington, DC 20503.
    Please do not return your completed form to the office of 
management and budget send it to the address provided by the 
sponsoring agency.


    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 cost) to 
ensure proper planning, management and completion of the project 
described in this application.
    2. Will give the awarding agency, the Comptroller General of the 
United States and, if appropriate, the State, through any authorized 
representative, access to and the right to examine all records, 
books, papers, or documents related to the award; and will establish 
a proper accounting system in accordance with generally accepted 
accounting standards or agency directives.
    3. Will establish safeguards to prohibit employees from using 
their positions for a purpose that constitutes or presents the 
appearance of personal or organizational conflict of interest, or 
personal gain.
    4. Will initiate and complete the work within the applicable 
time frame after receipt of approval of the awarding agency.
    5. Will comply with the intergovernmental Personnel Act of 1970 
(42 U.S.C. Secs. 4728-4763) relating to prescribed standards for 
merit systems for programs funded under one of the 19 statutes or 
regulations specified in Appendix A or 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. Secs. 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. Secs. 3601 et seq.), as amended, relating to 
nondiscrimination in the sale, rental of financing of housing; (i) 
any other nondiscrimination provisions in specific statute(s) under 
which application for Federal assistance is being made; and, (j) the 
requirements of any other nondiscrimination statue(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, a applicable, with provisions of the Hatch Act 
(5 U.S.C. Secs. 1501-1508 and 7324-7328) which limit the political 
activities of employees whose principal employment activities are 
funded in whole or in part with Federal funds.
    9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40 
U.S.C. Sec. 276c and 18 U.S.C. Sec. 874), and the Contract Work 
Hours and Safety Standards Act (40 U.S.C. Secs. 327-333), regarding 
labor standards for federally-assisted construction subagreements.
    10. Will comply, if applicable, with flood insurance purchase 
requirements of Section 102(a) of the Flood Disaster Protection Act 
of 1973 (P.L. 93-234) which requires recipients in a special flood 
hazard area to participate in the program and to purchase flood 
insurance if the total cost of insurable construction and 
acquisition is $10,000 or more.
    11. Will comply with environmental standards which may be 
prescribed pursuant to the following: (a) Institution of 
environmental quality control measures under the National 
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order 
(EO) 11514; (b) notification of violating facilities pursuant to EO 
11738; (c) protection of wetlands pursuant to EO 11990; (d) 
evaluation of flood hazards in floodplains in accordance with EO 
11988; (e) assurance of project consistency with the approved State 
management program developed under the Coastal Zone Management Act 
of 1972 (16 U.S.C. Secs. 1451 et seq.); (f) conformity of Federal 
actions to State (Clean Air) Implementations Plans under Section 
176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. 
Secs. 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 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. Sec. 470), EO 11593 (identification and 
protection of historic properties), and the Archaeological and 
Historic Preservation Act of 1974 (16 U.S.C. Secs. 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. Secs. 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 Amendments 
of 1996 and OMB Circular No. A-133, ``Audits of States, Local 
Governments, and Non-Profit Organizations.''
    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
----------------------------------------------------------------------
Applicant Organization-------------------------------------------------
Title------------------------------------------------------------------
Date Submitted---------------------------------------------------------

Certification Regarding Drug-Free Workplace Requirements

    This certification is required by the regulations implementing 
the Drug-Free Workplace Act of 1988: 45 CFR Part 76, Subpart, F. 
Sections 76.630(c) and (d)(2) and 76.645(a)(1) and (b) provide that 
a Federal agency may designate a central receipt point for STATE-
WIDE AND STATE AGENCY-WIDE certifications, and for notification of 
criminal drug convictions. For the Department of Health and Human 
Services,

[[Page 14588]]

the central pint is: Division of Grants Management and Oversight, 
Office of Management and Acquisition, Department of Health and Human 
Services, Room 517-D, 200 Independence Avenue, SW Washington, DC 
20201.

Certification Regarding Drug-Free Workplace Requirements 
(Instructions for Certification)

    1. By signing and/or submitting this application or grant 
agreement,the grantee is providing the certification set out below.
    2. The certification set out below is a material representation 
of fact upon which reliance is placed when the agency awards the 
grant. If it is later determined that the grantee knowingly rendered 
a false certification, or otherwise violates the requirements of the 
Drug-Free Workplace, Act, the agency, in addition to any other 
remedies available to the Federal Government, may take action 
authorized under the Drug-Free Workplace Act.
    3. For grantees other than individuals. Alternate I applies.
    4. For grantees who are individuals, Alternate II applies.
    5. Workplaces under grants, for grantees other than individuals, 
need not be identified on the certification, If known, they may be 
identified in the grant application. If the grantee does not 
identify the workplaces at the time of application, or upon award, 
if there is no application, the grantee must keep the identity of 
the workplace(s) on file in its office and make the information 
available for Federal inspection. Failure to identify all known 
workplaces constitutes a violation of the grantee's drug-free 
workplace requirements.
    6. Workplace identifications must include the actual address of 
buildings (or parts of buildings) or other sites where work under 
the grant takes place. Categorical descriptions may be used (e.g., 
all vehicles of a mass transit authority of State highway department 
while in operation, State employees in each local unemployment 
office, performers in concert halls or radio studios).
    7. If the workplace identified to the agency changes during the 
performance of the grant, the grantee shall inform the agency of the 
change(s), if it previously identified the workplaces in question 
(see paragraph five).
    8. Definitions of terms in the Nonprocurement Suspension and 
Debarment common rule and Drug-Free Workplace common rule apply to 
this certification. Grantees' attention is called, in particular, to 
the following definitions from these rules:
    Controlled substance means a controlled substance in Schedules I 
through V of the Controlled Substances Act (21 U.S.C. 812) and as 
further defined by regulation (21 CFR 1308.11 through 13208.15);
    Conviction means a finding of guilt (including a plea of nolo 
contendere) or imposition of sentence, or both, by any judicial body 
charged with the responsibility to determine violations of the 
Federal or State criminal drug statutes;
    Criminal drug statute means a Federal or non-Federal criminal 
statute involving the manufacture, distribution, dispensing, use, or 
possession of any controlled substance;
    Employee means the employee of a grantee directly engaged in the 
performance of work under a grant, including: (i) All direct charge 
employees; (ii) All indirect charge employees unless their impact or 
involvement is insignificant to the performance of the grant; and, 
(iii) Temporary personnel and consultants who are directly engaged 
in the performance of work under the grant and who are on the 
grantee's payroll. This definition does not include workers not on 
the payroll of the grantee (e.g., volunteers, even if used to meet a 
matching requirement; consultants or independent contractors not on 
the grantee's payroll; or employees of subrecipients or 
subcontractors in covered workplaces).

Certification Regarding Drug-Free Workplace Requirements

Alternate I. (Grantees Other Than Individuals)

    The grantee certifies that it will or will continue to provide a 
drug-free workplace by:
    (a) Publishing a statement notifying employees that the unlawful 
manufacture, distribution, dispensing, possession, or use of a 
controlled substance is prohibited in the grantee's workplace and 
specifying the actions that will be taken against employees for 
violation of such prohibition;
    (b) Establishing an ongoing drug-free awareness program to 
inform employees about--
    (1) The dangers of drug abuse in the workplace;
    (2) The grantee's policy of maintaining a drug-free workplace;
    (3) Any available drug counseling, rehabilitation, and employee 
assistance programs; and
    (4) The penalties that may be imposed upon employees for drug 
abuse violations occurring in the workplace;
    (c) Making it a requirement that each employee to be engaged in 
the performance of the grant be given a copy of the statement 
required by paragraph (a);
    (d) Notifying the employee in the statement required by 
paragraph (a) that, as a condition of employment under the grant, 
the employee will--
    (1) Abide by the terms of the statement; and
    (2) Notify the employer in writing of his or her conviction for 
a violation of a criminal drug statute occurring in the workplace no 
later than five calendar days after such conviction;
    (e) Notifying the agency in writing, within ten calendar days 
after receiving notice under paragraph (d)(2) from an employee or 
otherwise receiving actual notice of such conviction. Employers of 
convicted employees must provide notice, including position title, 
to every grant officer or other designee on whose grant activity the 
convicted employee was working, unless the Federal agency has 
designated a central point for the receipt of such notices. Notice 
shall include the identification number(s) of each affected grant;
    (f) Take one of the following action, within 30 calendar days of 
receiving notice under paragraph (d)(2), with respect to any 
employee who is so convicted--
    (1) Taking appropriate personnel action against such an 
employee, up to and including termination, consistent with the 
requirements of the Rehabilitation Act of 1973, as amended; or
    (2) Requiring such employee to participate satisfactorily in a 
drug abuse assistance or rehabilitation program approved for such 
purposes by a Federal, State, or local health, law enforcement, or 
other appropriate agency;
    (g) Making a good faith effort to continue to maintain a drug-
free workplace through implementation of paragraphs (a), (b), (c), 
(d), (e) and (f).
    (B) The grantee may inset in the space provided below the 
site(s) for the performance of work done in connection with the 
specific grant:
    Place of Performance (Street address, city, county, state, zip 
code)
----------------------------------------------------------------------
----------------------------------------------------------------------
    Check if there are workplaces on file that are not identified 
here.

Alternate II. (Grantees Who Are Individuals)

    (a) The grantee certifies that, as a condition of the grant, he 
or she will not engage in the unlawful manufacture, distribution, 
dispensing, possession, or use of a controlled substance in 
conducting any activity with the grant;
    (b) If convicted of a criminal drug offense resulting from a 
violation occurring during the conduct of any grant activity, he or 
she will report the conviction, in writing, within 10 calendar days 
of the conviction, to every grant officer or other designee, unless 
the Federal agency designates a central point for the receipt of 
such notices. When notice is made to such a central point, it shall 
include the identification number(s) of each effected grant. [55 FR 
21690, 21702, May 25, 1990]

Certification Regarding Debarment, Suspension, and Other Responsibility 
Matters

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

Instructions for Certification

    1. By signing and submitting this proposal, the prospective 
primary participant is providing the certification set out below.
    2. The inability of a person to provide the certification 
required below will not necessarily result in denial of 
participation in this covered transaction. The prospective 
participant shall submit an explanation of why it cannot provide the 
certification set out below. The certification or explanation will 
be considered in connection with the department or agency's 
determination whether to enter into the transaction. However, 
failure of the prospective primary participant to furnish a 
certification or an explanation shall disqualify such person from 
participation in this transaction.
    3. The certification in this clause is a material representation 
of fact upon which reliance was placed when the department or agency 
determined to enter into this transaction. If it is later determined 
that the prospective primary participant knowingly rendered an 
erroneous certification, in addition to other remedies available to 
the Federal Government, the department or

[[Page 14589]]

agency may terminate this transaction for cause of default.
    4. The prospective primary participant shall provide immediate 
written notice to the department or agency to which this proposal is 
submitted if at any time the prospective primary participant learns 
that its certification was erroneous when submitted or has become 
erroneous by reason of changed circumstances.
    5. The terms covered transaction, debarred, suspended, 
ineligible, lower tier covered transaction, participant, person, 
primary covered transaction, principal, proposal, and voluntarily 
excluded, as used in this clause, have the meanings set out in the 
Definitions and Coverage sections of the rules implementing 
Executive Order 12549. You may contact the department or agency to 
which this proposal is being submitted for assistance in obtaining a 
copy of those regulations.
    6. The prospective primary participant agrees by submitting this 
proposal that, should the proposed covered transaction be entered 
into, it shall not knowingly enter into any lower tier covered 
transaction with a person who is proposed for debarment under 48 CFR 
part 9, subpart 9.4, debarred, suspended, declared ineligible, or 
voluntarily excluded from participation in this covered transaction, 
unless authorized by the department or agency entering into this 
transaction.
    7. The prospective primary participant further agrees by 
submitting this proposal that it will include the clause titled 
``Certification Regarding Debarment, Suspension, Ineligibility and 
Voluntary Exclusion-Lower Tier Covered Transaction,'' provided by 
the department or agency entering into this covered transaction, 
without modification, in all lower tier covered transactions and in 
all solicitations for lower tier covered transactions.
    8. A participant in a covered transaction may rely upon a 
certification of a prospective participant in a lower tier covered 
transaction that it is not proposed for debarment under 48 CFR part 
9, subpart 9.4, debarred, suspended, ineligible, or voluntarily 
excluded from the covered transaction, unless it knows that the 
certification is erroneous. A participant may decide the method and 
frequency by which it determines the eligibility of its principals. 
Each participant may, but is not required to, check the List of 
Parties Excluded from Federal Procurement and Nonprocurement 
Programs.
    9. Nothing contained in the foregoing shall be construed to 
require establishment of a system of records in order to render in 
good faith the certification required by this clause. The knowledge 
and information of a participant is not required to exceed that 
which is normally possessed by a prudent person in the ordinary 
course of business dealings.
    10. Except for transactions authorized under paragraph 6 of 
these instructions, if a participant in a covered transaction 
knowingly enters into a lower tier covered transaction with a person 
who is proposed for debarment under 48 CFR part 9, subpart 9.4, 
suspended debarred, ineligible, or voluntarily excluded from 
participation in this transaction, in addition to other remedies 
available to the Federal Government, the department or agency may 
terminate this transaction for cause or default.

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

    (1) The prospective primary participant 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 by any 
Federal department of agency;
    (b) Have not within a three-year period preceding this proposal 
been convicted of or had a civil judgment rendered against them for 
commission of fraud or a criminal offense in connection with 
obtaining, attempting to obtain, or performing a public (Federal, 
State or local) transaction or contract under a public transaction; 
violation of Federal or State antitrust statutes or commission of 
embezzlement, theft, forgery, bribery, falsification or destruction 
of records, making false statements, or receiving stolen property;
    (c) Are not presently indicted for 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 three-year period preceding this 
application/proposal had one or more public transactions (Federal, 
State or local) terminated for cause or default.
    (2) Where the prospective primary participant is unable to 
certify to any of the statements in this certification, such 
prospective participant shall attach an explanation to this 
proposal.

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

Instructions for Certification

    1. By signing and submitting this proposal, the prospective 
lower tier participant is providing the certification set out below.
    2. The certification in this clause is a material representation 
of fact upon which reliance was placed when this transaction was 
entered into. If it is later determined that the prospective lower 
tier participant knowingly rendered an erroneous certification, in 
addition to other remedies available to the Federal Government the 
department or agency with which this transaction originated may 
pursue available remedies, including suspension and/or debarment.
    3. The prospective lower tier participant shall provide 
immediate written notice to the person to which this proposal is 
submitted if at any time the prospective lower tier participant 
learns that its certification was erroneous when submitted or had 
become erroneous by reason of changed circumstances.
    4. The terms covered transaction, debarred, suspended, 
ineligible, lower tier covered transaction, participant, person, 
primary covered transaction, principal, proposal, and voluntarily 
excluded, as used in this cause, have the meaning set out in the 
Definitions and Coverage sections of rules implementing Executive 
Order 12549. You may contact the person to which this proposal is 
submitted for assistance in obtaining a copy of those regulations.
    5. The prospective lower tier participant agrees by submitting 
his proposal that, [[Page 33043]] should the proposed covered 
transaction be entered into, it shall not knowingly enter into any 
lower tier covered transaction with a person who is proposed for 
debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, 
declared ineligible, or voluntarily excluded from participation in 
this covered transaction, unless authorized by the department or 
agency with which this transaction originated.
    6. The prospective lower tier participant further agrees by 
submitting this proposal that it will include this clause titled 
``Certification Regarding Debarment, Suspension, Ineligibility and 
Voluntary Exclusion--Lower Tier Covered Transaction,'' without 
modification, in all lower tier covered transactions and in all 
solicitations for lower tier covered transactions.
    7. A participant in a covered transaction may rely upon a 
certification of a prospective participant in a lower tier covered 
transaction that it is not proposed for debarment under 48 CFR part 
9, subpart 9.4, debarred, suspended, ineligible, or voluntarily 
excluded from covered transactions, unless it knows that the 
certification is erroneous. A participant may decide the method and 
frequency by which it determines the eligibility of its principals. 
Each participant may, but is not required to, check the List of 
Parties Excluded from Federal Procurement and Nonprocurement 
Programs.
    8. Nothing contained in the foregoing shall be construed to 
require establishment of a system of records in order to render in 
good faith the certification required by this clause. The knowledge 
and information of a participant is not required to exceed that 
which is normally possessed by a prudent person in the ordinary 
course of business dealings.
    9. Except for transactions authorized under paragraph 5 of these 
instructions, if a participant in a covered transaction knowingly 
enters into a lower tier covered transaction with a person who is 
proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, 
debarred, ineligible, or voluntarily excluded from participation in 
this transaction, in addition to other remedies available to the 
Federal Government, the department or agency with which this 
transaction originated may pursue available remedies, including 
suspension and/or debarment.

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

    (1) The prospective lower tier participant certifies, by 
submission of this proposal, that neither it nor its principals is 
presently debarred, suspended, proposed for debarment, declared 
ineligible, or voluntarily

[[Page 14590]]

excluded from participation in this transaction by any Federal 
department or agency.
    (2) Where the prospective lower tier participant is unable to 
certify to any of the statements in this certification, such 
prospective participant shall attach an explanation to this 
proposal.

Certification Regarding Environmental Tobacco Smoke

    Public Law 103227, Part C Environmental Tobacco Smoke, also 
known as the Pro Children Act of 1994, requires that smoking not be 
permitted in any portion of any indoor routinely owned or leased or 
contracted for by an entity and used routinely or regularly for 
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 the children's services and that all 
subgrantees shall certify accordingly.

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 an 
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.

Statement for Loan Guarantees and Loan Insurance

    The undersigned states, to the best of his or her knowledge and 
belief, that:
    If any funds have been paid or will be paid to any person for 
influencing or attempting to influence an officer or employee of any 
agency, a Member of Congress, an officer or employee of Congress, or 
an employee of a Member of Congress in connection with this 
commitment providing for the United States to insure or guarantee a 
loan, the undersigned shall complete and submit Standard Form-LLL 
``Disclosure form to Report Lobbying,'' in accordance with its 
instructions. Submission of this statement is a prerequisite for 
making or entering into this transaction imposed by section 1352, 
title 31, U.S. Code. Any person who fails to file the required 
statement shall be subject to a civil penalty of not less than 
$10,000 and not more than $100,000 for each such failure.

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

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

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

BILLING CODE 4184-01-M

[[Page 14591]]

[GRAPHIC] [TIFF OMITTED] TN17MR00.003


BILLING CODE 4184-01-C

[[Page 14592]]

Attachment F-2

Instructions for Completion of SF-LLL, Disclosure of Lobbying 
Activities

    This disclosure form shall be completed by the reporting entity, 
whether subawardee or prime Federal recipient, at the initiation or 
receipt of a covered Federal action, or a material change to a 
previous filing, pursuant to title 31 U.S.C. section 1352. The 
filing of a form is required for each payment or agreement to make 
payment to any lobbying entity 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 a covered Federal action. 
Complete all items that apply for both the initial filing and 
material change report. Refer to the implementing guidance published 
by the Office of Management and Budget for additional information.
    1. Identify the type of covered Federal action for which 
lobbying activity is and/or has been secured to influence the 
outcome of a covered Federal action.
    2. Identify the status of the covered Federal action.
    3. Identify the appropriate classification of this report. If 
this is a followup report caused by a material change to the 
information previously reported, enter the year and quarter in which 
the change occurred. Enter the date of the last previously submitted 
report by this reporting entity for this covered Federal action.
    4. Enter the full name, address, city, State and zip code of the 
reporting entity. Include Congressional District, if known. Check 
the appropriate classification of the reporting entity that 
designates if it is, or expects to be, a prime or subaward 
recipient. Identify the tier of the subawardee, e.g., the first 
subawardee of the prime is the 1st tier. Subawards include but are 
not limited to subcontracts, subgrants and contract awards under 
grants.
    5. If the organization filing the report in item 4 checks 
``Subawardee,'' then enter the full name, address, city, State and 
zip code of the prime Federal recipient. Include Congressional 
District, if known.
    6. Enter the name of the Federal agency making the award or loan 
commitment. Include at least one organizational level below agency 
name, if known. For example, Department of Transportation, United 
States Coast Guard.
    7. Enter the Federal program name or description for the covered 
Federal action (item 1). If known, enter the full Catalog of Federal 
Domestic Assistance (CFDA) number for grants, cooperative 
agreements, loans, and loan commitments.
    8. Enter the most appropriate Federal identifying number 
available for the Federal action identified in item 1 (e.g., Request 
for Proposal (RFP) number; Invitation for Bid (IFB) number; grant 
announcement number; the contract, grant, or loan award number; the 
application/proposal control number assigned by the Federal agency). 
Include prefixes, e.g., ``RFP-DE-90-001.''
    9. For a covered Federal action where there has been an award or 
loan commitment by the Federal agency, enter the Federal amount of 
the award/loan commitment for the prime entity identified in item 4 
or 5.
    10. (a) Enter the name, address, city, State and zip code of the 
lobbying registrant under the Lobbying Disclosure Act of 1995 
engaged by the reporting entity identified in item 4 to influence 
the covered Federal action.
    (b) Enter the full names of the individual(s) performing 
services, and include full address if different from 10(a). Enter 
Last Name, First Name, and Middle Initial (MI).
    11. The certifying official shall sign and date the form, print 
his/her name, title, and telephone number.
    According to the Paperwork Reduction Act, as amended, no persons 
are required to respond to a collection of information unless it 
displays a valid OMB Control Number. The valid OMB control number 
for this information collection is OMB No. 0348-0046. Public 
reporting burden for this collection of information is estimated to 
average 10 minutes per response, including time for reviewing 
instructions, searching existing data sources, gathering and 
maintaining the data needed, and completing and reviewing the 
collection of information. Send comments regarding the burden 
estimate or any other aspect of this collection of information, 
including suggestions for reducing this burden, to the Office of 
Management and Budget, Paperwork Reduction Project (0348-0046), 
Washington, DC 20503.

Attachment G

State Single Point of Contact Listing Maintained by OMB

    In accordance with Executive Order #12371, ``Intergovernmental 
Review of Federal Programs,'' Section 4, ``the Office of Management 
and Budget (OMB) shall maintain a list of official State entities 
designated by the States to review and coordinate proposed Federal 
financial assistance and direct Federal development.'' This attached 
listing is the OFFICIAL OMB LISTING. This listing is also published 
in the Catalogue of Federal Domestic Assistance biannually

August 23, 1999--OMB State Single Point of Contact Listing*

Arizona

Joni Saad
Arizona State Clearinghouse
3800 N. Central Avenue
Fourteenth Floor
Phoenix, Arizona 85012
Telephone: (602) 280-1315
FAX: (602) 280-8144

Arkansas

Mr. Tracy L. Copeland
Manager, State Clearinghouse
Office of Intergovernmental Services
Department of Finance and Administration
515 W. 7th St., Room 412
Little Rock, Arkansas 72203
Telephone: (501) 682-1074
FAX: (501) 682-5206

California

Grants Coordination
State Clearinghouse
Office of Planning & Research
1400 Tenth Street, Room 121
Sacramento, California 95814
Telephone: (916) 445-0613
FAX: (916) 323-3018

Delaware

Francine Booth
State Single Point of Contact
Executive Department
Office of the Budget
540 S. Dupont Highway--Suite 5
Dover, Delaware 19901
Telephone: (302) 739-3326
FAX: (302) 739-5661

District of Columbia

Charles Nichols
State Single Point of Contact
Office of Grants Mgmt. & Dev.
717 14th Street, N.W. Suite 1200
Washington, D.C. 20005
Telephone: (202) 727-1700 (direct)
(202) 727-6537 (secretary)
FAX: (202) 727-1617

Florida

Florida State Clearinghouse
Department of Community Affairs
2555 Shumard Oak Blvd.
Tallahassee, Florida 32399-2100
Telephone: (850) 922-5438
FAX: (850) 414-0479
Contact: Cherie Trainor (850) 414-5495

Georgia

Deborah Stephens, Coordinator
Georgia State Clearinghouse
270 Washington Street, S.W.--8th Floor
Atlanta, Georgia 30334
Telephone: (404) 656-3855
FAX: (404) 656-7901

Illinois

Virginia Bova, State Single Point of Contact
Illinois Department of Commerce and Community Affairs
James R. Thompson Center
100 West Randolph, Suite 3-400
Chicago, Illinois 60601
Telephone: (312) 814-6028
FAX: (312) 814-1800

Indiana

Renee Miller
State Budget Agency
212 State House
Indianapolis, Indiana 46204-2796
Telephone: (317) 233-2971 (directline)
FAX: (317) 233-3323

Iowa

Steven R. McCann
Division for Community Assistance
Iowa Department of Economic Development
200 East Grand Avenue
Des Moines, Iowa 50309
Telephone: (515) 242-4719
FAX: (515) 242-4809

Kentucky

Kevin J. Goldsmith, Director
Sandra Brewer, Executive Secretary
Intergovernmental Affairs
Office of the Governor
700 Capitol Avenue
Frankfort, Kentucky 40601

[[Page 14593]]

Telephone: (502) 564-2611
FAX: (502) 564-0437

Maine

Joyce Benson
State Planning Office
184 State Street
38 State House Station
Augusta, Maine 04333
Telephone: (202) 287-3261
FAX: (202) 287-6489

Maryland

Linda Janey
Manager, Plan & Project Review
Maryland Office of Planning
301 W. Preston Street--Room 1104
Baltimore, Maryland 21201-2365
Staff Contact: Linda Janey
Telephone: (410) 767-4490
FAX: (410) 767-4480

Michigan

Richard Pfaff
Southeast Michigan Council of Governments
660 Plaza Drive--Suite 1900
Detroit, Michigan 48226
Telephone: (313) 961-4266
FAX: (313) 961-4869

Mississippi

Cathy Mallette
Clearinghouse Officer
Department of Finance and Administration
550 High Street
303 Walters Sillers Building
Jackson, Mississippi 39201-3087
Telephone: (601) 359-6762
FAX: (601) 359-6758

Missouri

Lois Phol
Federal Assistance Clearinghouse
Office of Administration
P.O. Box 809
Jefferson Building, 9th Floor
Jefferson City, Missouri 65102
Telephone: (314) 751-4834
FAX: (314) 751-7819

Nevada

Department of Administration
State Clearinghouse
209 E. Musser Street, Room 220
Carson City, Nevada 89710
Telephone: (702) 687-4065
FAX: (702) 687-3983
Contact: Heather Elliot (702) 687-6367

New Hampshire

Jeffrey H. Taylor
Director, New Hampshire Office of State Planning
Attn: Intergovernmental Review Process
Mike Blake
2\1/2\ Beacon Street
Concord, New Hampshire 03301
Telephone: (603) 271-2155
FAX: (603) 271-1728

New Mexico

Nick Mandell
Local Government Division
Room 201 Bataan Memorial Building
Santa Fe, New Mexico 87503
Telephone: (505) 827-3640
FAX: (505) 827-4984

New York

New York State Clearinghouse
Division of the Budget
State Capitol
Albany, New York 12224
Telephone: (518) 474-1605
FAX: (518) 486-5617

North Carolina

Jeanette Furney
North Carolina Department of Administration
116 West Jones Street--Suite 5106
Raleigh, North Carolina 27603-8003
Telephone: (919) 733-7232
FAX: (919) 733-9571

North Dakota

North Dakota Single Point of Contact
Office of Intergovernmental Assistance
600 East Boulevard Avenue
Bismarck, North Dakota 58505-0170
Telephone: (701) 224-2094
FAX: (701) 224-2308

Rhode Island

Kevin Nelson, Review Coordinator
Department of Administration
Division of Planning
One Capitol Hill, 4th Floor
Providence, Rhode Island 02908-5870
Telephone: (401) 277-2656
FAX: (401) 277-2083

South Carolina

Omeagia Burgess
State Single Point of Contact
Budget and Control Board
Office of State Budget
1122 Ladies Street--12th Floor
Columbia, South Carolina 29201
Telephone: (803) 734-0494
FAX: (803) 734-0645

Texas

Tom Adams
Governor's Office
Director, Intergovernmental Coordination
P.O. Box 12428
Austin, Texas 78711
Telephone: (512) 463-1771
FAX: (512) 936-2681

Utah

Carolyn Wright
Utah State Clearinghouse
Office of Planning and Budget
Room 116 State Capitol
Salt Lake City, Utah 84114
Telephone: (801) 538-1027
FAX: (801) 538-1547

West Virginia

Fred Cutlip, Director
Community Development Division
W. Virginia Development Office
Building #6, Room 553
Charleston, West Virginia 25305
Telephone: (304) 558-4010
FAX: (304) 558-3248

Wisconsin

Jeff Smith
Section Chief, Federal/State Relations
Wisconsin Department of Administration
101 East Wilson Street--6th Floor
P.O. Box 7868
Madison, Wisconsin 53707
Telephone: (608) 266-0267
FAX: (608) 267-6931

Wyoming

Sandy Ross
State Single Point of Contact
Department of Administration and Information
2001 Capitol Avenue, Room 214
Cheyenne, WY 82002
Telephone: (307) 777-5492
FAX: (307) 777-3696

Territories

Guam

Joseph Rivera, Acting Director
Bureau of Budget and Management Research
Office of the Governor
P.O. Box 2950
Agana, Guam 96932
Telephone: (671) 475-9411 or 9412
FAX: (671) 472-2825

Puerto Rico

Jose Caballero-Mercado, Chairman
Puerto Rico Planning Board
Federal Proposals Review Office
Minillas Government Center
P.O. Box 41119
San Juan, Puerto Rico 00940-1119
Telephone: (787) 727-4444
(787) 723-6190
FAX: (787) 724-3270

North Marina Islands

Mr. Alvaro A. Santos, Executive Officer
Office of Management and Budget
Officer of the Governor
Saipan, MP 96950
Telephone: (670) 664-2256
FAX: (670) 664-2272
Contact person: Ms. Jacoba T. Seman, Federal Programs Coordinator
Telephone: (670) 664-2289
FAX: (670) 664-2272

Virgin Islands

Nellon Bowry
Director, Office of Management and Budget
#41 Norregade Emancipation Garden
Station, Second Floor
Saint Thomas, Virgin Islands 00802

    Please direct all questions and correspondence about 
intergovernmental review to: Linda Clarke Telephone (809) 774-0750 
FAX: (809) 776-0069.
    If you would like a copy of this list faxed to your office, 
please call our publications office at: (202) 395-9068
    *In accordance with Executive Order #12372, ``Intergovernmental 
Review of Federal Programs,'' this listing represents the designed 
State Single Points of Contact. The jurisdictions not listed no 
longer participate in the process BUT GRANT APPLICANTS ARE STILL 
ELIGIBLE TO APPLY FOR THE GRANT EVEN IF YOUR STATE, TERRITORY, 
COMMONWEALTH, ETC DOES NOT HAVE A ``STATE SINGLE POINT OF CONTACT.'' 
STATES WITHOUT ``STATE SINGLE POINTS OF CONTACT'' INCLUDE: Alabama, 
Alaska; American Samoa; Colorado; Connecticut; Hawaii; Idaho; 
Kansas; Louisiana; Massachusetts, Minnesota; Montana; Nebraska; New 
Jersey; Ohio; Oklahoma; Oregon; Palau;

[[Page 14594]]

Pennsylvania; South Dakota; Tennessee; Vermont, Virginia; and 
Washington. This list is based on the most current information 
provided by the States. Information on any changes or apparent 
errors should be provided to the Office of Management and Budget and 
the State in question. Changes to the list will only be made upon 
formal notification by the State. Also, this listing is published 
biannually in the Catalogue of Federal Domestic Assistance.

[FR Doc. 00-6547 Filed 3-16-00; 8:45 am]
BILLING CODE 4184-01-M