[Federal Register Volume 69, Number 22 (Tuesday, February 3, 2004)]
[Notices]
[Pages 5171-5178]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-2174]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

[Program Announcement No. FV02-2004]


Family Violence Prevention and Services Program

AGENCY: Family and Youth Services Bureau, Administration on Children, 
Youth and Families, (ACYF) and the Office of Community Services (OCS), 
Administration for Children and Families, Department of Health and 
Human Services.

ACTION: Notice of the availability of funding to Native American 
Tribes, Alaskan Villages, and Tribal organizations for family violence 
prevention and services.

-----------------------------------------------------------------------

SUMMARY: This announcement governs the proposed award of formula grants 
under the Family Violence Prevention and Services Act to Native 
American Tribes, Alaskan Villages, and Tribal organizations. The 
purpose of these grants is to assist Tribes 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. *Grantees are to be mindful that 
although the expenditure period for grants is a two year period, an 
application is required every year to provide continuity in the 
provision of services. (See B. Expenditure Period).

DATES: Applications for FY 2004 Native American Tribes, Alaskan 
Villages, and Tribal Organizations grant awards meeting the criteria 
specified in this instruction should be received no later than February 
21, 2003.

ADDRESSES: Applications should be sent to Family and Youth Services 
Bureau, Administration on Children, Youth and Families, Administration 
for Children and Families, Attn: William Riley, 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 Native American and Alaskan Native Villages Grantee Conference

    The annual grantee conference 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 Tribal 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), Pub. L. 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 impact 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.
    The physical and cultural obstacles existing in much of Indian 
country compound the basic dynamics of domestic violence. Barriers such 
as the isolation of vast rural areas, the concern

[[Page 5172]]

for safety in isolated settings, and the transportation requirements 
over long distances, heighten the need for the coordination of the 
services through an often limited delivery system.
    It is estimated that between 12 percent and 35 percent of women 
visiting emergency rooms with injuries are there because of battery. In 
a project intended to broaden the reach of the Native American domestic 
violence community, the Indian Health Service (IHS) and FVPSA have 
collaborated to oversee the development of domestic violence community 
projects. These projects are designed to develop improved health care 
responses to domestic violence and to facilitate collaboration between 
the local health care system and local American Indian and Alaskan 
Native domestic violence advocacy programs. In this effort the IHS also 
is collaborating with representatives of Mending the Sacred Hoop, 
Cangleska, Inc., and the Family Violence Prevention Fund to provide 
training, technical assistance and oversight to the pilot projects.
    To help bring about a more effective response to the problem of 
domestic violence, the Department of Health and Human Services (HHS) 
urges Native American Tribes, Alaskan Native Villages, and Tribal 
organizations receiving funds under this grant announcement to 
coordinate activities under this grant with other new and existing 
resources for the prevention of family and intimate violence.

Programmatic and Funding Information

A. Background

    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, 
reauthorized and amended in 1992 by Pub. L. 102-295, in 1994 by Pub. L. 
103-322, the Violent Crime Control and Law Enforcement Act, in 1996 by 
Pub. L. 104-235, the Child Abuse Prevention and Treatment Act (CAPTA) 
of 1996, and in 2000 by the ``Victims of Trafficking and Violence 
Protection Act'' (Pub. L. 106-386, 10/28/2000). The Act was most 
recently amended by the Keeping Children and Families Safe Act of 2003, 
Pub. L. 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, 227 grants were made to States and Native American 
Tribes. The Department also made 53 family violence prevention grant 
awards to nonprofit State domestic violence coalitions.
    In addition, the Department supports the Domestic Violence Resource 
Center Network (DVRN). The DVRN consist of 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, the Resource Center 
for the Elimination of Domestic Violence Against Native Women (Sacred 
Circle), 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 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 TDY 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 this 
separate announcement 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. Additionally, in a subsequent announcement, 10 percent will 
be allocated 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 FVPSA FY 2004 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 
family violence prevention and services funding 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. Native American Tribal Allocations

    The Secretary is required to make 10 percent of amounts 
appropriated under section 310(a) for grants to Native American Tribes. 
Native American Tribes and Tribal organizations are eligible for 
funding under this program if they meet the definition of such entities 
as found in the Indian Self-Determination and Education Assistance Act, 
25 U.S.C. 450, and are able to demonstrate their capacity to carry out 
a family violence prevention and services program.
    Any Native American Tribe that believes it meets the eligibility 
criteria should provide supportive documentation in its application and 
a request for inclusion on the list of eligible tribes. (See Native 
American Tribal Application Requirements.)
    In computing Native American Tribal allocations, we will use the 
latest available population figures from the Census Bureau. Where 
Census Bureau data are unavailable, we will use figures from the BIA 
Indian Population and Labor Force Report.
    Because section 304 of the Act specifies a minimum base amount for 
State allocations, we have set a base amount for Native American Tribal 
allocations. Since FY 1986, we have found, in practice, that the 
establishment of a base amount has facilitated our efforts to make a 
fair and equitable distribution of limited grant funds.
    Due to the expanded interest in the prevention of family violence 
and in the provision of services to victims of family violence and 
their dependents, we have received an increasing number of tribal 
applications over the past several years. In order to ensure the 
continuance of an equitable distribution of family violence prevention 
and services funding in response to the

[[Page 5173]]

increased number of tribes that apply, we have adjusted the funding 
formula for the allocation of family violence funds.
    Native American Tribes which meet the application requirements and 
whose reservation and surrounding Tribal Trust Lands population is:
     Less than or equal to 1,500 will receive a 
minimum base amount of $1,500;
     Greater than 1,500 but less than 3,001 will 
receive a minimum base amount of $3,000;
     Between 3,001 and 4,000 will receive a minimum 
base amount of $4,000; and
     Between 4,001 and 5,000 will receive a minimum 
base amount of $5,000.
    The minimum base amounts are in relation to the Tribe's population 
and the progression of an additional $1,000 per 1,000 persons in the 
population range continues until the Tribe's population is 50,000.
    Tribes with a population of 50,000 to 100, 000 will receive a 
minimum of $50,000, and Tribes with a population of 100,001 to 150,000 
will receive a minimum of $100,000.
    Once the base amounts have been distributed to the Tribes that have 
applied for family violence funding, the ratio of the Tribe's 
population to the total population of all the applicant Tribes is then 
considered in allocating the remainder of the funds. With the 
distribution of a proportional amount plus a base amount to the Tribes 
we have accounted for the variance in actual population and scope of 
the family violence programs. Under the previous allocation plan we did 
not have a method by which to consider the variance in tribal census 
counts. As in previous years, Tribes are encouraged to apply as 
consortia for the family violence funding.

General Grant Requirements for Native American Tribes

A. Definitions

    Native American Tribes 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) Indian Tribe and Tribal organization: Have the same meanings 
given such terms in subsections (b) and (c), respectively, of section 4 
of the Indian Self-Determination and Education Assistance Act.
    (3) 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.
    (4) 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 to 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 services promoting 
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, 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 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 obligation 
through October 1, 2004.
    Reallotted funds, if any, are available for expenditure until the 
end of the fiscal year following the fiscal year that the funds became 
available for reallotment. FY 2004 grant funds which are made available 
to Tribes and Tribal Organizations through reallotment, under section 
304(d)(2), must be expended by the grantee no later than September 30, 
2005.

C. Reporting Requirements

    Section 303(a)(4) requires that a performance report be filed with 
the Department describing the activities carried out, and including 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 application certifying performance of such 
services. Consortia grantees should compile performance reports into a 
comprehensive report for submission.
    Please note that section 303(a)(4) of the FVPS Act also requires 
that the director of the FVPS 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 number of shelters and shelter programs (safe homes/
motels, etc.) assisted by FVPSA program funding. Data elements should 
include:
     The number of shelters.
     The number of women sheltered.
     The number of young children sheltered (birth-12 
years of age).
     The number of teenagers and young adults (13-17 
years of age).
     The number of men sheltered.
     The number of the elderly serviced.
     The average length of stay.
     The number of women, children, teens, and other 
who were turned away because shelter was unavailable.

[[Page 5174]]

     The number of women, children, teens, and others 
were referred to other shelters due to 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:
     The elderly.
     Individuals with physical challenges.
     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.
     Services to Children.
     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 (if available) the number of women, 
children, and men who were identified as victims of physical, sexual, 
and/or 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.)
     Physical abuse.
     Alcohol abuse.
     Drug abuse.
     Batterer intervention services.
     Child abuse.
     Witnessed abuse.
     Emergency medical intervention.
     Law enforcement intervention.
    The performance report should include narratives of success stories 
about 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 Tribe or Tribal 
organization were addressed, and what special emphases were placed on 
these activities;
     A description of the specific services and 
facilities that your program 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 those persons geographically isolated were 
addressed; and
     A description and assessment of the prevention 
activities supported during the program year, e.g., community education 
events, and public awareness efforts.
    Performance reports for the Tribes, Alaskan Native Villages and 
Tribal organizations are due on an annual basis on December 30 of each 
year.

D. Departmental Grants Management Reports

    All grantees are reminded that the annual Program Reports and 
annual Financial Status Reports (Standard Form 269) are due 90 days 
after the end of the expenditure period, i.e., December 30 of each 
year.

Application Requirements for Native American Tribes, Alaskan Native 
Villages and Tribal Organziations

A. Eligibility

    As described above, Native American Tribes, Tribal organizations, 
and Alaskan Native Villages are eligible for funding under this program 
if they meet the definition of such entities as found in subsections 
(b) and (c) of section 4 of the Indian Self-Determination and Education 
Assistance Act and are able to demonstrate their capacity to carry out 
a family violence prevention and services program.
    Any Native American Tribe or Tribal organization that believes it 
meets the eligibility criteria and should be included in the list of 
eligible tribes should provide supportive documentation and a request 
for inclusion in its application. (See Application Content Requirements 
below.)
    As in previous years, Native American Tribes may apply singularly 
or as a consortium. In addition, a non-profit private organization, 
approved by a Native American Tribe for the operation of a family 
violence shelter or program on a reservation is eligible for funding.

B. Additional Information on Eligibility

Approval/Disapproval of a Tribal, Alaskan Village, or Tribal 
Organization Application
    The Secretary will approve any application that meets the 
requirements of the Act and this Announcement, and will not disapprove 
an application unless the applicant organization has been given 
reasonable notice of the Department's intention to disapprove and an 
opportunity to correct any deficiencies (section 303(a)(3)).
    All applicants must have 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.
    Private, non-profit organizations are encouraged to submit with 
their applications the survey located under ``Grant Related Documents 
and Forms'' titled ``Survey for Private, Non-Profit Grant Applicants.'' 
The forms are located on the web at http://www.acf.hhs.gov/programs/ofs/forms.htm.

C. Application Content Requirements

    The application from the Native American Tribe, Tribal 
organization, or Alaskan Native Village must be signed by the Chief 
Executive Officer or Tribal Chairperson of the applicant organization.
    (1) The name of the organization or agency and the Chief Program 
Official designated as responsible for administering funds under the 
Act, and the name, telephone number, and fax number, if available, of a 
contact person in the designated organization or agency.
    (2) A copy of a current resolution stating that the designated 
organization or agency has the authority to submit an application on 
behalf of the Native American individuals in the Tribe(s) or Village(s) 
and to administer programs and activities funded under this program 
(section 303(b)(2)).
    (3) A description of the procedures designed to involve 
knowledgeable individuals and interested organizations in providing 
services under the Act (section 303(b)(2)). For example, knowledgeable 
individuals and interested organizations may include: Tribal officials 
or social services staff involved in child abuse or family violence 
prevention, Tribal law

[[Page 5175]]

enforcement officials, representatives of State coalitions against 
domestic violence, and operators of family violence shelters and 
service programs.
    (4) A description of the applicant's operation of and/or capacity 
to carry out a family violence prevention and services program. This 
might be demonstrated in ways such as the following:
    (a) The current operation of a shelter, safe house, or family 
violence prevention program;
    (b) The establishment of joint or collaborative service agreements 
with a local public agency or a private non-profit agency for the 
operation of family violence prevention activities or services; or
    (c) The operation of social services programs as evidenced by 
receipt of ``638'' contracts with the Bureau of Indian Affairs (BIA); 
Title II Indian Child Welfare grants from the BIA; Child Welfare 
Services grants under Title IV-B of the Social Security Act; or Family 
Preservation and Family Support grants under title IV-B of the Social 
Security Act.
    (5) A description of the services to be provided, how the applicant 
organization plans to use the grant funds to provide the direct 
services, to whom the services will be provided, and the expected 
results of the services.
    (6) Documentation of the procedures 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)).
    (7) The EIN number of the applicant organization submitting the 
application.
    D. Each application must contain the following assurances:
    (a) That not less than 70 percent of the funds shall be used for 
immediate shelter and related assistance for victims of family violence 
and their dependents and not less than 25% of the funds distributed 
shall be used to provide related assistance (section 303(g)).
    (b) That grant funds made available under the Act will not be used 
as direct payment to any victim or dependent of a victim of family 
violence (section 303(d)).
    (c) That the address or location of any shelter or facility 
assisted under the Act will not be made public, except with the written 
authorization of the person or persons responsible for the operations 
of such shelter (section 303(a)(2)(E)).
    (d) That law or procedure has been implemented for the eviction of 
an abusing spouse from a shared household (section 303(a)(2)(F)).
    (e) That applicant will comply with the applicable Departmental 
recordkeeping and reporting requirements and general requirements for 
the administration of grants under 45 CFR part 92.
    Additional Forms: Private, non-profit organizations may submit with 
their applications the additional suvey located under ``Grant Related 
Documents and Forms'' titled ``Survey for Private, Non-Profit Grant 
Applicants'' at http://www.acf.hhs.gov/program/ofs/form.htm.

Other Information

A. Notification Under Executive Order 12372

    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. Required Certifications

    All applications must submit or comply with the required 
certifications found at the Appendices as follows:
     Anti-Lobbying Certification and Disclosure Form 
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 
applicants intent to comply with the Drug-Free Workplace requirements 
and compliance with the Debarment Certification. The Drug-Free 
Workplace and 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 applicants intent to comply with the requirements of the 
Pro-Children Act of 1994 (Act). 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 29, 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; and
    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 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

[[Page 5176]]

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

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.
    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 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,

[[Page 5177]]

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 and 
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 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;

[[Page 5178]]

    (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)

-----------------------------------------------------------------------

-----------------------------------------------------------------------

    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. 04-2174 Filed 2-2-04; 8:45 am]
BILLING CODE 4184-01-P