[Federal Register Volume 70, Number 54 (Tuesday, March 22, 2005)]
[Notices]
[Pages 14467-14472]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-5555]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration on Children, Youth and Families

[Program Announcement No. FV01-2005]


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) 2005.
    CFDA Number: 93.671, Family Violence Prevention and Services.

DATES: Applications for FY 2005 State grant awards meeting the criteria 
specified in this instruction should be received no later than April 
21, 2005.

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

    State Family Violence Prevention and Services Act (FVPSA) 
administrators should plan to attend the annual State Administrators 
Grantee Conference. A subsequent Program Instruction and/or Information 
Memorandum 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 victims of 
domestic violence, sexual assault, and stalking. It is essential that 
the confidentiality of adult victims and their children receiving FVPSA 
services be protected. Consequently, when providing statistical data on 
program activities and program services, 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), P.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, have been transferred to the U.S. Department of Health and Human 
Services during FY 2004 in accordance with the Act for support of 
services to children and youth exposed to domestic violence. It is 
projected that additional Stamp revenues will be received during FY 
2005. 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, social service providers (which may include faith-based 
organizations), 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, 
42 U.S.C. 10401, et seq.) is entitled the Family Violence Prevention 
and

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Services Act (the Act). The Act was first implemented in FY 1986, was 
amended in 1992 by Pub. L. 102-295, in 1994 by Pub. L. 103-322, in 1996 
by Pub. L. 104-235, and in 2000 by the Victims of Trafficking and 
Violence Protection Act (Pub. L. 106-386). 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, Native 
American Tribes (including Alaskan Native 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 2004, 224 grants were made to States and Tribes or Tribal 
organizations. 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

    For FY 2005, The Department of Health and Human Services will make 
available for grants to designated State agencies seventy percent of 
the amount appropriated under section 310(a)(1) of the Family Violence 
Prevention and Services Act which is not reserved under section 
310(a)(2). In separate announcements the Department will allocate 10 
percent of the foregoing appropriation to the Tribes 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 amount appropriated under section 310(a)(1) of 
the Family Violence Prevention and Services Act which is not reserved 
under section 310(a)(2) will be available in FY 2005 to continue the 
support for the National Resource Center and the four Special Issue 
Resource Centers. Additional funds appropriated under the FVPSA will be 
used to support other activities, including training and technical 
assistance, collaborative projects with advocacy organizations and 
service providers, data collection efforts, public education 
activities, research and other demonstration projects as well as the 
ongoing operation of the National Domestic Violence Hotline.

C. State Allocation

    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 (section 304(a)(2)). State populations are 
determined on the basis of the most recent census data available to the 
Secretary and, if available, the annual current census data produced by 
the Secretary of Commerce pursuant to section 181 of Title 13.
    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 (section 304(a)(1)).

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;

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    (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 Period

    The FVPSA funds may be used for expenditures from 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 
2005 funds may be used for expenditures from October 1, 2004 through 
September 30, 2006.
    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, 2006.

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. Section 303(a)(5) requires that 
the State file a report that contains a description of the activities 
carried out with funds expended for State administrative costs.
    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. 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 men who were 
turned away because shelter was unavailable
     The number of women, children, teens, and men 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). Performance reports 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.
    Please note that section 303(a)(4) of the FVPSA requires the 
Department to suspend funding for an approved application if any State 
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. Financial Status Reports

    All State grantees are reminded that the annual Financial Status 
Reports (Standard Form SF-269A) are due 90 days after the end of each 
Federal fiscal year. The first SF-269A is due December 29, 2005. The 
final SF-269A is due December 29, 2006. Completed reports should be 
sent to: Doris Lee, Division of Mandatory Grants, Office of Grants 
Management, Office of Administration, Administration for Children and 
Families, 370 L'Enfant Promenade SW., Washington, DC 20447. Standard 
Form 269A can be found at:

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http://www.whitehouse.gov/omb/grants/grants_forms.html

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, and the Commonwealth of the 
Northern Mariana Islands.
    In the past, Guam, American Samoa, the Virgin Islands and the 
Commonwealth of the Northern Mariana Islands have applied for funds as 
a part of their consolidated grant 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 & Bradstreet Universal Numbering 
System (DUNS) number. On June 27, 2003, the Office of Management and 
Budget published in the Federal Register a new Federal policy 
applicable to all Federal grant applicants. The policy requires all 
Federal grant applicants to provide a Dun & Bradstreet Data Universal 
Numbering System (DUNS) number when applying for Federal grants or 
cooperative agreements on or after October 1, 2003. The DUNS number 
will be required whether an applicant is submitting a paper application 
or using the government-wide electronic portal (http://www.Grants.gov). 
A DUNS number will be required for every application for a new award or 
renewal/continuation of an award, including applications or plans under 
formula, entitlement, and block grant programs, submitted on or after 
October 1, 2003.
    Please ensure that your organization has a DUNS number. You may 
acquire a DUNS number at no cost by calling the dedicated toll-free 
DUNS number request line on 1-866-705-5711 or you may request a number 
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 submitted by the Chief Executive 
Officer of the State and signed by the Chief Executive Officer 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 coordination of related programs within the State, 
and the name of a contact person if different from the Chief Program 
Official (section 303(a)(2)(D)).
    (2) A plan describing in detail how the needs of underserved 
populations will be met, such as populations which are underserved due 
to ethnic, racial, cultural, or language diversity; alienage status; 
geographic isolation; disability; or age (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, knowledgeable 
individuals and interested organizations, and 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) of the Act 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 Chapter 110 of Title 42 of the 
U.S. Code 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

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include any Federal funds provided under any authority other than this 
chapter (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, programs or other activities funded by the 
State in whole or in part with funds made available under the FVPSA 
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 will 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.

Other Information

A. Notification Under Executive Order 12372

    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.

B. The Paperwork Reduction Act of 1995 (Pub. L. 104-13)

    Public reporting burden for this collection of information is 
estimated to average six hours per response, including the time for 
reviewing instructions, gathering and maintaining the data needed and 
reviewing the collection information.
    The project description is approved under OMB control number 0970-
0274 which expires August 31, 2005. An agency may not conduct or 
sponsor, and a person is not required to respond to, a collection of 
information unless it displays a currently valid OMB control number.

C. Certifications

    Applications must comply with the required certifications found at 
the Appendices as follows:
    Anti-Lobbying Certification and Disclosure Form (See Appendix A): 
Applicants must furnish prior to award an executed copy of the Standard 
Form LLL, Certification Regarding Lobbying, when applying for an award 
in excess of $100,000. Applicants who have used non-Federal funds for 
lobbying activities in connection with receiving assistance under this 
announcement shall complete a disclosure form, if applicable, with 
their applications (approved by the Office of Management and Budget 
under control number 0348-0046). Applicants must sign and return the 
certification with their application.
    Certification Regarding Environmental Tobacco Smoke (See Appendix 
B): Applicants must also understand they will be held accountable for 
the smoking prohibition included within Public Law 103-227, Title XII 
Environmental Tobacco Smoke (also known as the PRO-KIDS Act of 1994). A 
copy of the Federal Register notice which implements the smoking 
prohibition is included with forms. By signing and submitting the 
application, applicants are providing the certification and need not 
mail back the certification with the application.
    These certifications also may be found at: http://www.acf.hhs.gov/programs/ofs/forms.htm.

    Dated: March 14, 2005.
Joan E. Ohl,
Commissioner, Administration on Children, Youth and Families.

Appendices--Required Certifications:

A. Certification Regarding Lobbying
B. Certification 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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Appendix B--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

[[Page 14472]]

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.
[FR Doc. 05-5555 Filed 3-21-05; 8:45 am]
BILLING CODE 4184-01-P