[Federal Register Volume 69, Number 18 (Wednesday, January 28, 2004)]
[Notices]
[Pages 4163-4169]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-1771]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

[Program Announcement No. FV01-2004]


Family Violence Prevention and Services Program

AGENCY: Family and Youth Services Bureau (FYSB), Administration on 
Children, Youth and Families (ACYF), Administration for Children and 
Families, (ACF), Department of Health and Human Services (HHS).

ACTION: Notice of the availability of funding to States for family 
violence prevention and services.

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SUMMARY: This announcement governs the proposed award of formula grants 
under the Family Violence Prevention and Services Act to States 
(including Territories and Insular Areas). The purpose of these grants 
is to assist States in establishing, maintaining, and expanding 
programs and projects to prevent family violence and to provide 
immediate shelter and related assistance for victims of family violence 
and their dependents.
    This announcement sets forth the application requirements, the 
application process, and other administrative and fiscal requirements 
for grants in fiscal year (FY) 2004.

DATES: Applications for FY 2004 State grant awards meeting the criteria 
specified in this instruction should be received no later than February 
20, 2004.

ADDRESSES: Applications should be sent to Family and Youth Services 
Bureau, Administration on Children, Youth and Families, Administration 
for Children and Families, Attn: Ms. Sunni Knight, 330 C Street, SW., 
Room 2117, Washington, DC, 20447.

FOR FURTHER INFORMATION CONTACT: William D. Riley at (202) 401-5529; or 
e-mail at [email protected], or Sunni Knight at (202) 401-5319 or e-
mail at [email protected].

SUPPLEMENTARY INFORMATION:

Annual State Administrators Grantee Conference

    The annual grantee conference for the State FVPSA Administrators is 
a training and technical assistance activity. Attendance at these 
activities is mandatory. Family Violence Prevention and Services Act 
(FVPSA) funds may be used to support attendance and participation. A 
subsequent Program Instruction will advise the State FVPSA 
administrators of the date, time, and location of their grantee 
conference.

Client Confidentiality

    FVPSA programs must establish or implement policies and protocols 
for maintaining the safety and confidentiality of the adult victims and 
their children of domestic violence, sexual assault, and stalking. It 
is essential that the confidentiality of individuals receiving FVPSA 
services be protected. Consequently, when providing statistical data on 
program activities, individual identifiers of client records will not 
be used (section 303(a)(2)(E)).

Stop Family Violence Postal Stamp

    The U.S. Postal Service was directed by the ``Stamp Out Domestic 
Violence Act of 2001'' (the Act), Public Law 107-67, to make available 
a ``semipostal'' stamp to provide funding for domestic violence 
programs. Funds raised in connection with sales of the stamp, less 
reasonable costs, will be transferred to the U.S. Department of Health 
and Human Services in accordance with the Act for support of services 
to children and youth affected by domestic violence. It is projected 
that initial revenues will be received during the third quarter of FY 
2004. Subsequent to the receipt of the stamp proceeds, a program 
announcement will be issued providing guidance and information on the 
process and requirements for awards to programs providing services to 
children and youth.

The Importance of Coordination of Services

    The impacts of family and intimate violence include physical injury 
and death of primary or secondary victims, psychological trauma, 
isolation from family and friends, harm to children witnessing or 
experiencing violence in homes in which the violence occurs, increased 
fear, reduced mobility and employability, homelessness, substance 
abuse, and a host of other health and related mental health 
consequences.
    Coordination and collaboration among the police, prosecutors, the 
courts, victim services providers, child welfare and family 
preservation services, and medical and mental health service providers 
is needed to provide more responsive and effective services to victims 
of domestic violence and their families. It is essential that all 
interested parties are involved in the design and improvement of 
intervention and prevention activities.
    To help bring about a more effective response to the problem of 
domestic violence, the Department of Health and Human Services (HHS) 
urges the designated State agencies receiving funds under this grant 
announcement to coordinate activities funded under this grant with 
other new and existing resources for the prevention of family and 
intimate violence and related issues.

Programmatic and Funding Information

A. Background

    Title III of the Child Abuse Amendments of 1984 (Pub. L. 98-457,

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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, 
reauthorized and amended in 1992 by Public Law 102-295, in 1994 by 
Public Law 103-322, the Violent Crime Control and Law Enforcement Act, 
in 1996 by Public Law 104-235, the Child Abuse Prevention and Treatment 
Act (CAPTA) of 1996, the Victims of Trafficking and Violence Protection 
Act, Public Law 106-386, in 2000. The Act was most recently amended by 
the Keeping Children and Families Safe Act of 2003. Public Law 108-36.
    The purpose of this legislation is to assist States and Native 
American Tribes, Alaskan Villages and Tribal organizations in 
supporting the establishment, maintenance, and expansion of programs 
and projects to prevent incidents of family violence and to provide 
immediate shelter and related assistance for victims of family violence 
and their dependents.
    During FY 2003, 223 grants were made to States and Native American 
Tribes. The Department also made 53 family violence prevention grant 
awards to non-profit State domestic violence coalitions.
    In addition, the Department supports the National Resource Center 
for Domestic Violence (NRC) and four Special Issue Resource Centers 
(SIRCs). The SIRCs are the Battered Women's Justice Project, the 
Resource Center on Child Custody and Protection, Sacred Circle Resource 
Center for the Elimination of Domestic Violence Against Native Women 
and the Health Resource Center on Domestic Violence. The purpose of the 
NRC and the SIRCs is to provide resource information, training, and 
technical assistance to Federal, State, and Native American agencies, 
local domestic violence prevention programs, and other professionals 
who provide services to victims of domestic violence.
    In February, 1996, the Department funded the National Domestic 
Violence Hotline (NDVH) to ensure that every woman has access to 
information and emergency assistance wherever and whenever she needs 
it. The NDVH is a 24-hour, toll-free service which provides crisis 
assistance, counseling, and local shelter referrals to women across the 
country. Hotline counselors also are available for non-English speaking 
persons and for people who are hearing-impaired. The Hotline number is 
1-800-799-SAFE; the TDD number for the hearing impaired is 1-800-787-
3224. As of August 31, 2003 the National Domestic Violence Hotline had 
answered over 1 million calls.

B. Funds Available

    Of the total appropriation for the Family Violence Prevention and 
Services Program for FY 2004, The Department of Health and Human 
Services will allocate 70 percent to the designated State agencies 
administering Family Violence Prevention and Services programs. In 
separate announcements the Department will allocate 10 percent to the 
Tribes, Alaskan Villages and Tribal organizations for the establishment 
and operation of shelters, safe houses, and the provision of related 
services; and 10 percent to the State Domestic Violence Coalitions to 
continue their work within the domestic violence community by providing 
technical assistance and training, and advocacy services among other 
activities with local domestic violence programs and to encourage 
appropriate responses to domestic violence within the States.
    Five percent of the FY 2004 FVPSA appropriation will be available 
to continue the support for the National Resource Center and the four 
Special Issue Resource Centers. The remaining 5 percent of the FY 2004 
appropriation will be used to support training and technical 
assistance, collaborative projects with advocacy organizations and 
service providers, data collection efforts, public education 
activities, research and other demonstration activities at the national 
level through the competitive or discretionary grant process.

C. State Allocation

    The Secretary is required to make available not less than 70 
percent of amounts appropriated under Section 310(a) for grants to 
States.
    Family Violence grants to the States, the District of Columbia, and 
the Commonwealth of Puerto Rico are based on a population formula. Each 
State grant shall be $600,000 with the remaining funds allotted to each 
State on the same ratio as the population of the State has to the 
population of all States.
    For the purpose of computing allotments, the statute provides that 
Guam, American Samoa, the Virgin Islands, and the Northern Mariana 
Islands will each receive grants of not less than one-eighth of 1 
percent of the amounts appropriated.

General Grant Requirements Applicable to States

A. Definitions

    States should use the following definitions in carrying out their 
programs. The definitions are found in Section 320 of the Act.
    (1) Family Violence: Any act or threatened act of violence, 
including any forceful detention of an individual, which (a) results or 
threatens to result in physical injury and (b) is committed by a person 
against another individual (including an elderly person) to whom such 
person is or was related by blood or marriage or otherwise legally 
related or with whom such person is or was lawfully residing.
    (2) Shelter: The provision of temporary refuge and related 
assistance in compliance with applicable State law and regulation 
governing the provision, on a regular basis, which includes shelter, 
safe homes, meals, and related assistance to victims of family violence 
and their dependents.
    (3) Related assistance: The provision of direct assistance to 
victims of family violence and their dependents for the purpose of 
preventing further violence, helping such victims to gain access to 
civil and criminal courts and other community services, facilitating 
the efforts of such victims to make decisions concerning their lives in 
the interest of safety, and assisting such victims in healing from the 
effects of the violence. Related assistance includes:
    (a) Prevention services such as outreach and prevention services 
for victims and their children, assistance for children who witness 
domestic violence, employment training, parenting and other educational 
services for victims and their children, preventive health services 
within domestic violence programs (including nutrition, disease 
prevention, exercise, and prevention of substance abuse), domestic 
violence prevention programs for school age children, family violence 
public awareness campaigns, and violence prevention counseling services 
to abusers;
    (b) Counseling with respect to family violence, counseling or other 
supportive services by peers, individually or in groups, and referral 
to community social services;
    (c) Transportation and technical assistance with respect to 
obtaining financial assistance under Federal and State programs, and 
referrals for appropriate health-care services (including alcohol and 
drug abuse treatment), but shall not include reimbursement for any 
health-care services;
    (d) Legal advocacy to provide victims with information and 
assistance through the civil and criminal courts, and legal assistance; 
or
    (e) Children's counseling and support services, and child care 
services for

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children who are victims of family violence or the dependents of such 
victims, and children who witness domestic violence.

B. Expenditure Periods

    The FVPSA funds may be used for expenditures on and after October 1 
of each fiscal year for which they are granted, and will be available 
for expenditure through September 30 of the following fiscal year, 
i.e., FY 2004 funds may be used for expenditures from October 1, 2003 
through September 30, 2005. Funds will be available for obligations 
only through October 1, 2004.
    Re-allotted funds, if any, are available for expenditure until the 
end of the fiscal year following the fiscal year that the funds became 
available for re-allotment. FY 2004 grant funds which are made 
available to the States through re-allotment, under section 304(d)(2), 
must be expended by the State no later than September 30, 2005.

C. Reporting Requirements: State Performance Report

    Section 303(a)(4) requires that States file a performance report 
with the Department describing the activities carried out, and 
inclusion of an assessment of the effectiveness of those activities in 
achieving the purposes of the grant. A section of this performance 
report must be completed by each grantee or sub-grantee that performed 
the direct services contemplated in the State's application certifying 
performance of such services. State grantees should compile performance 
reports into a comprehensive report for submission.
    The Performance Report should include the following data elements 
as well as narrative examples of success stories about the services 
which were provided. Please note that Section 303 (a) (4) of the FVPSA 
also requires that the director of the program suspend funding for an 
approved application if an applicant fails to submit an annual 
Performance Report. The Performance Report should include the following 
data elements:
    Funding--The total amount of the FVPSA grant funds awarded; the 
percentage of funding used for shelters, and the percentage of funding 
used for related services and assistance.
    Shelters--The total number of shelters and shelter programs (safe 
homes/motels, etc.) assisted by FVPSA program funding. Data elements 
should include:
     The number of women sheltered
     The number of shelters and safe houses in the 
State
     The number of young children sheltered (birth-12 
years of age)
     The number of teenagers and young adults (13-18 
years of age)
     The number of men sheltered
     The number of elderly serviced
     The average length of stay
     The number of women, children, teens, and others 
who were turned away because shelter was unavailable
     The number of women, children, teens, and others 
who were referred to other shelters due to a lack of space
    Types of individuals served including special populations. Record 
information by numbers and percentages against the total population 
served. Individuals and special populations served should include:
     Racial identification;
     Cultural classification;
     Language (other than English);
     Geographically isolated from shelter (urban or 
rural);
     Women of color;
     Persons with disabilities; and
     other special needs populations.
    Related services and assistance. List the types of related services 
and assistance provided to victims and their family members by 
indicating the number of women, children, and men that have received 
services. Services and assistance may include but are not limited to 
the following:
     Individual counseling
     Group counseling
     Crisis intervention/hotline
     Information and referral
     Batterers support services
     Legal advocacy services
     Transportation
     Services to teenagers
     Child Care
     Training and technical assistance
     Housing advocacy
     Other innovative program activities
    Volunteers--List the total number of volunteers and hours worked
    Identified Abuse--Indicate the number of women, children, and men 
who were identified as victims of physical, sexual, and emotional 
abuse.
    Service referrals--List the number of women, children, and men 
referred for the following services: (Note: If the individual was 
identified as a batterer please indicate.)
     Alcohol abuse
     Drug abuse
     Batterer intervention services
     Abuse as a child
     Witnessed abuse
     Emergency medical intervention
     Law enforcement intervention
    The Performance Report should include narratives of success stories 
of services provided and the positive impact on the lives of children 
and families. Examples may include the following:

     An explanation of the activities carried out 
including an assessment of the major activities supported by the family 
violence funds, what particular priorities within the State were 
addressed, and what special emphases were placed on these activities;
     A description of the specific services and 
facilities that your agency funded, contracted with, or otherwise used 
in the implementation of your program (e.g., shelters, safe-houses, 
related assistance, programs for batterers);
     An assessment of the effectiveness of the direct 
service activities contemplated in the application;
     A description of how the needs of under-served 
populations, including populations under-served because of ethnic, 
racial, cultural, language diversity, or geographic isolation were 
addressed;
     A description and assessment of the prevention 
activities supported during the program year, e.g., community education 
events, and public awareness efforts; and
     A discussion of exceptional issues or problems 
arising, but not addressed in the application.
    Performance reports for the States are due on an annual basis at 
the end of the calendar year (December 29).
    The statute also requires the Department to suspend funding for an 
approved application if any applicant fails to submit an annual 
performance report or if the funds are expended for purposes other than 
those set forth under this announcement.

D. Reporting Requirements: Departmental Grants Management Reports

    All State grantees are reminded that the annual Program Reports and 
annual Financial Status Reports (Standard Form 269) are due 90 days 
after the end of each Federal fiscal year, i.e., reports are due on 
December 29 of each year.

Application Requirements

A. Eligibility

    ``States'' as defined in section 320 of the Act are eligible to 
apply for funds. The term ``State'' means each of the several States, 
the District of Columbia, the Commonwealth of Puerto Rico, Guam, 
American Samoa, the Virgin Islands, the Commonwealth of the Northern 
Mariana Islands.
    In the past, Guam, the Virgin Islands and the Commonwealth of the 
Northern Mariana Islands have applied for funds as a part of their 
consolidated grant

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under the Social Services Block grant. These jurisdictions need not 
submit an application under this Program Announcement if they choose to 
have their allotment included as part of a consolidated grant 
application.
Additional Information on Eligibility
    All applicants must have a Dun and Bradstreet Number (DUNS). A DUNS 
number will be required for every application for a new award or 
renewal/continuation of an award under formula, entitlement and block 
grant programs. A DUNS number may be acquired at no cost by calling the 
dedicated toll-free DUNS number request line at 1-866-705-5711 or a 
number may be requested on-line at http://www.dnb.com.

B. Approval/Disapproval of a State Application

    The Secretary will approve any application that meets the 
requirements of the Act and this announcement and will not disapprove 
any such application except after reasonable notice of the Secretary's 
intention to disapprove has been provided to the applicant and after a 
6-month period providing an opportunity for applicant to correct any 
deficiencies.
    The notice of intention to disapprove will be provided to the 
applicant within 45 days of the date of the application.

C. Content of the State Application

    The State's application must be signed by the Chief Executive of 
the State or the Chief Program Official designated as responsible for 
the administration of the Act.
    Each application must contain the following information or 
documentation:
    (1) The name of the State agency, the name of the Chief Program 
Official designated as responsible for the administration of funds 
under this Act, and the name of a contact person if different from the 
Chief Program Official (section 303(a)(2)(C)).
    (2) A plan describing in detail how the needs of underserved 
populations will be met, including populations underserved because of 
ethnic, racial, cultural, language diversity or geographic isolation 
(section 303(a)(2)(C)).
    (a) Identify the underserved populations that are being targeted 
for outreach and services.
    (b) In meeting the needs of the underserved population, describe 
the domestic violence training that will be provided to the individuals 
who will do the outreach and intervention to these populations. 
Describe the specific service environment, e.g., new shelters, services 
for the battered elderly, women of color etc.
    (c) Describe the public information component of the State's 
outreach program; describe the elements of your program that are used 
to explain domestic violence, the most effective and safe ways to seek 
help, identify available resources, etc.
    (3) Provide a complete description of the process and procedures 
used to involve State domestic violence coalitions and other 
knowledgeable individuals and interested organizations to assure an 
equitable distribution of grants and grant funds within the State and 
between rural and urban areas in the State (sections 303(a)(2)(C) and 
311(a)(5)).
    (4) Provide a complete description of the process and procedures 
implemented that allow for the participation of the State domestic 
violence coalition in planning and monitoring the distribution of grant 
funds and determining whether a grantee is in compliance with section 
303(a)(2)(A), and section 311(a)(5).
    (5) Provide a copy of the procedures developed and implemented that 
assure the confidentiality of records pertaining to any individual 
provided family violence prevention or treatment services by any 
program assisted under the Act (section 303(a)(2)(E)).
    (6) Include a description of how the State plans to use the grant 
funds, a description of the target population, the number of shelters 
to be funded, the services the state will provide, and the expected 
results from the use of the grant funds (section 303(a)(2)).
    (7) Provide a copy of the law or procedures that the State has 
implemented for the eviction of an abusive spouse from a shared 
household (section 303 (a)(2)(F)).
    Each application must contain the following assurances:
    (a) That grant funds under the Act will be distributed to local 
public agencies and nonprofit private organizations (including 
religious and charitable organizations and voluntary associations) for 
programs and projects within the State to prevent incidents of family 
violence and to provide immediate shelter and related assistance for 
victims of family violence and their dependents in order to prevent 
future violent incidents (section 303(a)(2) (A)).
    (b) That not less than 70 percent of the funds distributed shall be 
used for immediate shelter and related assistance, as defined in 
section 320(5)(A), to the victims of family violence and their 
dependents and not less than 25 percent of the funds distributed shall 
be used to provide related assistance (section 303(g)).
    (c) That not more than 5 percent of the funds will be used for 
State administrative costs (section 303(a)(2)(B)(i)).
    (d) That in distributing the funds, the States will give special 
emphasis to the support of community-based projects of demonstrated 
effectiveness carried out by non-profit private organizations, 
particularly those projects the primary purpose of which is to operate 
shelters for victims of family violence and their dependents and those 
which provide counseling, advocacy, and self-help services to victims 
and their children (section 303(a)(2)(B)(ii)).
    (e) That grants funded by the States will meet the matching 
requirements in section 303(f), i.e., not less than 20 percent of the 
total funds provided for a project under this title with respect to an 
existing program, and with respect to an entity intending to operate a 
new program under this title, not less than 35 percent. The local share 
will be cash or in kind; and the local share will not include any 
Federal funds provided under any authority other than this Title 
(section 303(f)).
    (f) That grant funds made available under this program by the State 
will not be used as direct payment to any victim or dependent of a 
victim of family violence (section 303(d)).
    (g) That no income eligibility standard will be imposed on 
individuals receiving assistance or services supported with funds 
appropriated to carry out the Act (section 303(e)).
    (h) That the address or location of any shelter-facility assisted 
under the Act will not be made public, except with the written 
authorization of the person or persons responsible for the operation of 
such shelter (section 303(a)(2)(E)).
    (i) That all grants made by the State under the Act will prohibit 
discrimination on the basis of age, handicap, sex, race, color, 
national origin or religion (section 307).
    (j) That funds made available under the FVPSA be used to supplement 
and not supplant other Federal, State, and local public funds expended 
to provide services and activities that promote the purposes of the 
FVPSA (section 303(a)(4).
    (k) That States will comply with the applicable Departmental 
recordkeeping and reporting requirements and general requirements for 
the administration of grants under 45 CFR Part 92.

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Other Information

A. Notification Under Executive Order 12372

    For States, this program is covered under Executive Order 12372, 
``Intergovernmental Review of Federal Programs,'' for State plan 
consolidation and implication only--45 CFR 100.12. The review and 
comment provisions of the Executive Order and Part 100 do not apply. 
Federally-recognized Native American Tribes are exempt from all 
provisions and requirements of E.O. 12372.

B. Paperwork Reduction Act

    In accordance with the Paperwork Reduction Act of 1980 (Pub. L. 96-
511), the application requirements contained in this instruction have 
been approved by the Office of Management and Budget under control 
number 0970-0062.

C. Certifications

    Applications must comply with the required certifications found at 
the Appendices as follows:
    Anti-Lobbying Certification and Disclosure Form: Pursuant to 45 CFR 
part 93, the certification must be signed and submitted with the 
application. If applicable, a standard form LLL, which discloses 
lobbying payments, must be submitted.
    Certification Regarding Drug-Free Workplace Requirements and the 
Certification Regarding Debarment: The signature on the application by 
the chief program official attests to the applicant's intent to comply 
with the Drug-Free Workplace requirements and compliance with the 
Debarment Certification. The Drug-Free Workplace certification does not 
have to be returned with the application.
    Certification Regarding Environmental Tobacco Smoke: The signature 
on the application by the chief program official attests to the 
applicant's intent to comply with the requirements of the Pro-Children 
Act of 1994. The applicant further agrees that it will require the 
language of this certification be included in any sub-awards which 
contain provisions for children's services and that all grantees shall 
certify accordingly.

(Catalog of Federal Domestic Assistance number 93.671, Family 
Violence Prevention and Services)


    Dated: January 21, 2004.
Clarence Carter,
Director, Office of Community Services, Administration for Children and 
Families.

Appendices--Required Certifications: Anti-Lobbying and Disclosure; 
Drug-Free Workplace; Regarding Debarment; Regarding Environmental 
Tobacco Smoke.

Appendix A--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 sub awards 
at all tiers (including subcontracts, sub grants, and contracts 
under grants, loans, and cooperative agreements) and that all sub 
recipients 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.
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Organization

Appendix B--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 this transaction. However, 
failure of the prospective primary participant to furnish a 
certification or an explanation shall disqualify such person from 
participation in this transaction.
    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 agency may terminate this 
transaction for cause or 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.

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    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 Non-procurement 
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 or 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 clause, 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 
this 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 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.

Appendix C--Certification Regarding Environmental Tobacco Smoke

    Public Law 103227, Part C Environmental Tobacco Smoke, also 
known as the Pro Children Act of 1994 (Act), requires that smoking 
not be permitted in any portion of any indoor 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

[[Page 4169]]

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.

Appendix D--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, 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 or 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 1308.15);
    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) Taking one of the following actions, 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 insert 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)
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    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 affected grant.
[FR Doc. 04-1771 Filed 1-27-04; 8:45 am]
BILLING CODE 4184-01-P