[Federal Register Volume 59, Number 90 (Wednesday, May 11, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11383]
[[Page Unknown]]
[Federal Register: May 11, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Administration on Aging
White House Conference on Aging; Program Announcement No. WHCoA
94-2; Availability of Funds and Request for Applications for Mini-
conferences
AGENCY: White House Conference on Aging, AoA, HHS.
ACTION: Announcement of availability of funds and request for
applications to conduct mini-conferences in preparation for the 1995
White House Conference on Aging.
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SUMMARY: the White House Conference on Aging (WHCoA) announces that it
will hold a competition for the funding of mini-conferences in
preparation for the 1995 White House Conference on Aging. Funding for
WHCoA grants is authorized by the Older Americans Act, Public Law 102-
375 and Public Law 103-171.
This program announcement consists of two parts. Part I provides
background information and describes the program under which the WHCoA
is inviting applications to be considered for funding. Part II
describes, in detail, the application process and provides guidance on
how to prepare and submit an application.
All of the forms necessary to submit an application are included
following Part II. They complete the application kit that an applicant
needs for preparing and for submitting an application under this
announcement.
Grants will be made under this announcement subject to the
availability of funds for the support of the program described herein.
DATES: The deadline date for the submission of applications is June 6,
1994.
ADDRESSES: Application receipt point: Department of Health and Human
Services; Administration on Aging, Office of Administration and
Management, 330 Independence Avenue, SW., room 4644, Washington, DC
20201, Attn: WHCoA-94-2.
FOR FURTHER INFORMATION CONTACT:
For programmatic information, contact Judy Satine, Department of Health
and Human Services, White House Conference on Aging, 501 School Street,
SW., 8th Floor, Washington, DC 20024, telephone (202) 245-7826. For
grant technical information, contact Margaret Tolson, AoA, see address
above, telephone (202) 401-0838.
SUPPLEMENTARY INFORMATION:
Part I. Background Information and Program Description
A. Statutory Authority
The statutory authority for awards made under this Announcement is
contained in the Older Americans Act as amended, Public Law 102-375 and
Public Law 103-171.
B. Eligible Applicants
In general, any eligible public or nonprofit private organization,
agency or institution is eligible to apply under this program
announcement. Any applicant that is not now a DHHS grantee should
include, with its application, Internal Revenue Service or other
legally recognized documentation of its nonprofit status. A nonprofit
applicant cannot be funded without proof of its status.
C. Program Description
President Clinton announced in February that he has formally called
for a White House Conference on Aging to be convened in May 1995.
Previous White House Conferences in 1961, 1971 and 1981 adopted
recommendations that resulted in local, state and Federal initiatives
which improved the security and well being of older Americans. The 1995
Conference will produce recommendations that will meet the needs of
Older Americans in the twenty-first century.
A White House Conference on Aging in intended to produce policy
recommendations to guide national aging policy over the next decade. In
Public Law 102-375, the Older Americans Act amendments of 1992,
Congress specifically identified six primary purposes for the
Conference. They are:
(1) To increase public awareness of the interdependence of
generations and the essential contributions of older individuals to
society for the well-being of all generations;
(2) To identify the problems facing older individuals and the
commonalities of the problems with problems of younger generations;
(3) To examine the well-being of older individuals including the
impact the wellness of older individuals has on our aging society;
(4) To develop such specific and comprehensive recommendations for
executive and legislative action as may be appropriate for maintaining
and improving the well-being of the aging;
(5) To develop recommendations for the coordination of Federal
policy with State and local needs and the implementation of such
recommendations; and
(6) To review the status and multigenerational value of
recommendations adopted at previous White House Conferences on Aging.
Of major significance to the 1995 White House Conference on Aging
in direct participation by individuals and organizations in the pre-
conference stages. As part of this grass roots effort, the WHCoA has
adopted a four pronged approach that includes local forums, mini-
conferences as well as State and Regional conferences. The purpose of
these events is to identify those issues of mutual concern to the aging
population and to develop recommendations that warrant specific
attention by the White House Conference of Aging. An integral part of
this strategy is the conduct of mini-conferences which are topic or
constituency specific. The recommendations from these conferences will
play an integral role in the development of the agenda for the 1995
Conference.
In order for a mini-conference to be considered for funding, the
proposed event must:
(1) Be a policy oriented event. The focus of the event must be
either:
(a) On one of the following specific Federal policy issues:
Interdependence of generations;
Older persons as community resources;
Employment and continued productivity opportunities for middle-aged and
older persons including training;
Home and community based long-term care services including caregivers
assistance and health promotion;
Housing and coordinated services;
Income security with particular emphasis on alleviating poverty;
National retirement policy including pre-retirement;
Crime;
Nutrition;
Disability and aging services;
Mental health and substance abuse;
Future of aging services to be reflected in the Older Americans Act;
Combatting false stereotypes;
Minority aging;
Biomedical and other appropriate research; and
Related topics to promote the independence, well-being and security of
older persons.
or
(b) On one of the following specific constituencies:
Older Women;
One of the following groups of minority elderly:
Native American
African American
Asian/Pacific Islanders
Hispanic
Elderly persons with disabilities.
(2) Should have substantial and significant input and participation
by older persons. It should involve older persons and organizations
representing older persons in the development and implementation of the
event. Efforts should be made to seek out an appropriately diverse
representation of interested parties.
(3) Provide at a maximum five recommendations that can be utilized
by the WHCoA. These recommendations must be:
(a) Well articulated;
(b) Based on demonstrated information, knowledge and consensus
reached at event;
(c) Have a reasonable prospect of being attainable within the
current political, economic, and fiscal environment;
(d) Received within 30 days after the mini-conference.
The report should devote no more than 3 pages double spaced per
recommendation for up to 5 recommendations (total maximum of 15 double
spaced pages).
(4) Provide an implementation plan to demonstrate:
(a) How they will plan, design, and carry out the mini-conference
including proposed date and location, proposed participants (audience
discussants and speakers) and cooperating organizations;
(b) How they will seek additional sources of support;
(c) What they will do as an advocacy group to ensure that their
recommendations, if adopted by the WHCoA, are implemented into public
policy.
(5) Be held by March 31, 1995.
(6) Be held in a location accessible to persons with disabilities.
(7) Not be a profit-making or fund-raising event although it is
permissible to charge a fee to recover the costs of the event.
Project Costs: It is expected that 12-15 projects at $6,000 each
will be funded by the WHCoA. Applicants are expected to obtain
additional funding from other sources and are encouraged to include
with their applications letters of commitment from other funding
sources.
Part II. Information and Guidelines for the Application Process and
Review
Part II of this Announcement contains general information for
potential applicants and basic guidelines for submitting applications
in response to this announcement. Application forms are provided along
with detailed instructions for developing and assembling the
application package for submittal to the White House Conference on
Aging. Specific eligibility guidelines were provided in the program
description above.
A. General Information
1. Review Process and Considerations for Funding
The following steps are involved in the review process.
a. Notification: All applicants will automatically be notified of
the receipt of their application and informed of the identification
number assigned to it.
b. Expert Review: Applications that conform to the requirements of
this program announcement will be reviewed and scored competitively
against the evaluation criteria specified in section D, below. This
independent review of applications is performed by panels consisting of
qualified persons. The scores and judgments of these expert reviewers
are a major factor in making award decisions.
c. Decision-Making Process: After the panel review session,
applicants may be contacted by WHCoA staff to furnish additional
information. Applicants who are contacted should not assume that
funding is guaranteed. An award is official only upon receipt of the
Financial Assistance Award (Form DGCM 3-785).
d. Timeframe: Applicants should be aware that the time interval
between the deadline for submission of applications and the award of a
grant may be several weeks in duration. This length of time is required
to review and process grant applications.
2. Notification Under Executive Order 12372
This is not a covered program under Executive Order 12372.
B. Deadline for Submission of Applications
The closing date for submission of applications is June 6, 1994.
Applications must be either sent or hand-delivered to the address
specified in Section C, below. Hand-delivered applications are accepted
during the normal working hours of 9 a.m. to 5:30 p.m., Eastern Time,
Monday through Friday. An application will meet the deadline if it is
either:
1. Received at the mailing address on or before the applicable
deadline date; or
2. Sent before midnight of the applicable deadline date as
evidenced by either: (1) A U.S. Postal Service receipt or postmark or
(2) a receipt from a commercial carrier. The application must also be
received in time to be considered under the competitive independent
review mandated by Chapter 1-62 of the DHHS Grants Administration
Manual. Applicants are strongly advised to obtain proof that the
application was sent by the applicable deadline date. If there is a
question as to when an application was sent, applicants will be asked
to provide proof that they have met the applicable deadline date.
Private metered postmarks are not acceptable as proof of a timely
submittal.
Applications which do not meet the above deadlines are considered
late applications and will not be considered for funding.
C. Application Screening Requirements
All applications will be screened to determine completeness and
conformity to the requirements of this announcement. These screening
requirements are intended to assure a level playing field for all
applicants. Applications which fail to meet one or more of the criteria
described below will not be reviewed and will receive no further
consideration for funding. Complete, conforming applications will be
reviewed and scored competitively.
In order for an application to be reviewed, it must meet the
following screening requirements:
1. The application must not exceed 10 pages, double-spaced,
exclusive of certain required forms and assurances which are listed
below. Applications whose typescript is single-spaced or space-and-a-
half will be considered only if it is determined the applicant has not
thereby gained a competitive advantage. The following documents are
excluded from the 10 page limitation: (1) Standard Forms (SF) 424, 424A
(including up to a four page budget justification) and 424B; (2) the
certification forms regarding lobbying; debarment, suspension, and
other responsibility matters; and drug-free workplace requirements; and
(3) proof of non-profit status.
2. Applications submitted under this announcement must be either
postmarked by midnight, June 6, 1994, or hand-delivered by 5:30 p.m.,
Eastern Time, on June 6, 1994 to the address provided below: Department
of Health and Human Services, Administration on Aging, Office of
Administration and Management, 330 Independence Avenue, SW., room 4644,
Washington, DC 20201, Attn: AoA-94-2.
3. Applicants must meet the specific eligibility requirements set
forth above in the program description.
Under No Circumstances Will Applications That Do Not Meet These
Screening Requirements Be Assigned To Reviewers
D. Evaluation Criteria
Applications which pass the screening will be evaluated by an
independent review panel of at least three individuals. These reviewers
will be primarily experts from within the Federal government. Based on
the specific programmatic considerations set forth in the announcement,
the reviewers will comment on and score the applications, focusing
their comments and scoring decisions on the criteria below.
1. Purpose and Need for Assistance: 20 points
a. Does the proposed project clearly and adequately respond to the
stated requirements for a mini-conference?
b. Does the proposed project address one of the listed topics/
constituency groups in a relevant and thorough manner?
2. Approach/Method--Implementation and Activities: 30 points
a. Does the application clearly express and organize an
implementation plan which systematically includes specific objectives
and tasks which will result in an effective mini-conference?
b. Does the implementation plan include timelines for
accomplishment of tasks and objectives? Is the sequence and timing of
events logical and realistic?
c. Do the proposed presenters have demonstrated qualifications
which are appropriate for their roles?
3. Anticipated Outcomes: 30 points
a. Does the proposal include a plan for advocacy which is likely to
increase public awareness of the recommendations from the mini-
conference? Is this advocacy plan adequate for communicating
recommendations to all appropriate audiences? Does it provide a
realistic plan to achieve implementation of the recommendations should
they be adopted by the 1995 White Conference on Aging?
4. Level of Effort: 20 points
a. Are the qualifications of the key organizers of the mini-
conference appropriate for their roles?
b. Does the organization have a track record which demonstrates its
capability and knowledge to conduct the mini-conference?
E. The Components of an Application
To expedite the processing of applications, we request that you
arrange the components of your application, the original and two
copies, in the following order:
SF 424, Application for Federal Assistance; SF 424A,
Budget, accompanied by your budget justification; SF 424B (Assurances);
and the certification forms regarding lobbying; debarment, suspension,
and other responsibility matters; and drug-free workplace requirements.
Note: The original copy of the application must have an original
signature in item 18d on the SF 424.
Proof of nonprofit status, as necessary:
Project summary description;
Program narrative.
The original and each copy should be stapled securely (front and
back if necessary) in the upper left corner. Pages should be numbered
sequentially. In order to facilitate the handling and reproduction of
the application for purposes of the review, please do not use covers,
binders or tabs.
F. Communications With WHCoA
Do not include a self-addressed, stamped acknowledgment card. All
applicants will be notified by mail of the receipt of their application
and informed of the identification number assigned to it. This number
should be referred to in all subsequent communication with WHCoA
concerning the application.
After an identification number is assigned and the applicant has
been notified of the number, applications are filed numerically by
identification number for quick retrieval. It will not be possible for
WHCoA staff to provide a timely response to inquiries about a specific
application unless the identification number is given.
Applicants are advised that, prior to reaching a decision, the
WHCoA will not release information relative to an application other
than that it has been received and that it is being reviewed.
Unnecessary inquiries delay the process. Once a decision is reached,
the applicant will be notified as soon as possible of the acceptance or
rejection of the application.
G. Completing the Application
To assist applicants in completing Forms SF 424 and SF 424A
correctly, samples of completed forms have been provided as part of
this announcement. These samples are to be used as a guide only. Be
sure to submit your application on the blank copies. Please prepare
your application consistent with the following guidance:
1. SF 424, Cover Page: Complete only the items specified in the
following instructions:
Item 1. Enter an ``X'' in the block marked Application--Non-
construction.
Item 2. Fill in the date you submitted the application. Leave the
applicant identifier box blank.
Item 3. Not applicable.
Item 4. Leave blank.
Item 5. Provide the legal name of applicant; the name of the
primary organizational unit which will undertake the assistance
activity; the applicant address; and the name and telephone number of
the person to contact on matters related to this application.
Item 6. Enter the employer identification number (EIN) of the
applicant organization as assigned by the Internal Revenue Service.
Please include the suffix to the EIN, if known.
Item 7. Enter the appropriate letter in the box provided.
Item 8. Place an ``X'' in the box marked New.
Item 9. Enter the White House Conference on Aging.
Item 10. Leave blank.
Item 11. The title should describe concisely the nature of the
project. Try not to exceed 10 to 12 words and 120 characters including
spaces and punctuation.
Item 12. Not applicable.
Item 13. Enter the desired start date for the project and the
desired end date for the project. The project must be completed by
March 31, 1995.
Item 14. List the applicant's Congressional District and the
District(s), if any, directly affected by the proposed project.
Item 15. Enter the funding request to the WHCoA under Item 15a,
Federal. Enter the applicant's share of the project costs under 15b,
Applicant. If there are third party contributions, enter those under
Item 15e, Other. Enter the sum of these amounts under Item 15g, Total.
Item 16. Enter ``No'' under Item b.
Item 17. This question applies to the applicant organization, not
the person who signs as the authorized representative. Categories of
debt include delinquent audit disallowances, loans and taxes.
Item 18. To be signed by an authorized representative of the
applicant organization. A document attesting to that sign-off authority
must be on file in the applicant's office.
2. SF 424A--Budget Information
This form (SF424A) is designed to apply for funding under more than
one grant program; thus, for purposes of this WHCoA program, most of
the budget item columns/blocks are superfluous and should be regarded
as not applicable. The applicant should consider and respond to only
the budget items for which guidance is provided below. Section A--
Budget Summary and Section B--Budget Categories should include both
Federal and non-Federal funding for the proposed project.
Section A--Budget Summary
On line 5, enter total Federal Costs in column (e) and total Non-
Federal Costs (including third party in-kind contributions but not
program income) in column (f). Enter the total of columns (e) and (f)
in column (g).
Section B--Budget Categories
Use only the last column under Section B, namely the column headed
Total (5), to enter the total requirements for funds (combining both
the Federal and non-Federal shares) by object class category.
A brief budget justification should be appended to this Section
which shows the breakdown of budget cost items by Federal and non-
Federal shares and justifies each of the major items, personnel,
travel, other, etc.
Line 6a--Personnel: Enter total costs of salaries and wages of
applicant/grantee staff. Do not include the costs of consultants, which
should be included under 6h--Other.
Line 6b--Fringe Benefits: Enter the total costs of fringe benefits.
Line 6c--Travel: Enter total costs of out-of-town travel (travel
requiring per diem) for staff of the project. Do not enter costs for
consultant's travel or local transportation.
Line 6d--Equipment: Enter the total cost of all equipment to be
acquired by the project. The threshold for equipment is $500 or more
per unit.
Line 6e--Supplies: Enter the total costs of all tangible expendable
personal property (supplies) other than those included on line 6d.
Line 6f--Contractual: Enter of total costs of all contracts, if
applicable. Do not include payments to individuals on this line.
Line 6g--Construction: Not applicable.
Line 6h--Other: Enter the total of all other costs. Such costs,
where applicable, may include, but are not limited to: insurance,
medical and dental costs; noncontractual fees and travel paid directly
to individual consultants; local transportation (all travel which does
not require per diem is considered local travel); space and equipment
rentals; printing and publication; computer use; training cost,
including tuition and stipends, training service costs including wage
payments to individuals and supportive service payments; and staff
development costs.
Line 6i--Total Direct Charges: Show the totals of Lines 6a through
6h.
Line 6j--Indirect Charges: Not applicable.
Line 6k--Total: Enter the total amounts from Line 6i.
Section C--Non-Federal Resources
Line 12--Totals: As applicable, enter amounts of non-Federal
resources that will be used in carrying out the proposed project. If
third-party in-kind contributions are included, provide a brief
explanation in the budget justification section.
Section D--Forecasted Cash Needs:
Not applicable.
Section E--Budget Estimate of Federal Funds Needed for Balance of the
Project
Line 20--Totals: Not applicable.
Section F--Other Budget Information
Line 21--Direct Charges: Not applicable
Line 22--Indirect Charges: Not applicable
Line 23--Remarks: Provide any other explanations or comments deemed
necessary.
3. SF 424B--Assurances
Applicants are required to file an SF 424B, Assurances--Non-
Construction Programs. Please note that a duly authorized
representative of the applicant organization must certify that the
applicant is in compliance with these assurances.
With the possible exception of an Assurance of Protection of Human
Subjects, no other assurances are required. For research projects in
which human subjects may be at risk, an Assurance of Protection of
Human Subjects may be needed. If there is a question regarding the
applicability of this assurance, contact the Office for Protection from
Research Risks of the National Institutes of Health at (301) 496-7041.
4. Certification Forms
Certifications are required of the applicant regarding: (1)
Lobbying; (b) debarment, suspension, and other responsibility matters;
and (3) drug-free workplace requirements. Please note that a duly
authorized representative of the applicant organization must attest to
the applicant's compliance with these certifications.
5. Project Summary Description
On a separate page, provide a project summary description headed by
the name of the applicant organization as shown in SF 424, item 5.
Please limit the summary description to a maximum of 1,200 characters,
including words, spaces and punctuation.
The description should be specific and succinct. It should outline
the objectives of the mini-conference, the approaches to be used and
the outcomes expected.
6. Program Narrative
The Program Narrative is the critical part of the application. It
should be clear, concise, and, of course, responsive to the program
under which the application is being submitted. In describing your
proposed project, make certain that you respond fully to the evaluation
criteria set forth in Section D above. The format of the narrative
should, in fact, parallel the criteria.
Please have the narrative typed on one side of 8\1/2\'' x 11''
plain white paper with 1'' margins on both sides. All pages of the
narrative (including charts, tables, maps, exhibits, etc.) should be
sequentially numbered, beginning with ``Purpose and Need for
Assistance'' as page number one. (Applicants should not submit
reproductions of larger size paper, reduced to meet the size
requirement).
The narrative should also identify the author(s) of the proposal,
their relationship with the applicant, and the role they will play, if
any, should the project be funded.
This narrative guidance is in accordance with that provided in OMB
Circular A-102. The checklist reporting form (Section H, below) is
consistent with that approved under OMB control number 0937-0189.
H. Points to Remember
1. There is a 10 double-spaced page limitation for the substantive
parts of the application. Before submitting your application, please
check that you have adhered to this requirement which is spelled out in
Section C.
2. You are required to send an original and two copies of an
application.
3. The summary description (1,200 characters or less) should
accurately reflect the nature and scope of the proposed project.
4. In following the required format for preparing the program
narrative, make certain that you have responded fully to the four (4)
evaluative criteria which will be used by reviewers to evaluate and
score all applications.
5. Before submitting the application, have someone other than the
author(s): (1) apply the screening requirements to make sure you are in
compliance; and (2) carry out a trial run review based upon the
evaluative criteria. Take the opportunity to consider the results of
the trial run and then make whatever changes you deem appropriate.
6. Applications must be mailed by midnight, or hand-delivered by
5:30 p.m., Eastern Time, on June 6, 1994 to the address below.
Department of Health and Human Services, Administration on Aging,
Office of Administration and Management, 330 Independence Avenue SW.,
Room 4644, Washington, D.C. 20201, Attn: WHCoA-94-2,
Fernando M. Torres-Gil,
Assistant Secretary for Aging.
BILLING CODE 4130-02-M
TN11MY94.000
BILLING CODE 4130-02-C
Instructions for the SF 424
This is a standard form used by applicants as a required facesheet
for preapplications and applications submitted for Federal assistance.
It will be used by Federal agencies to obtain applicant certification
that States which have established a review and comment procedure in
response to Executive Order 12372 and have selected the program to be
included in their process, have been given an opportunity to review the
applicant's submission.
Item and Entry
1. Self-explanatory.
2. Date application submitted to Federal agency (or State if
applicable) & applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new project, leave
blank.
5. Legal name of applicant, name of primary organizational unit which
will undertake the assistance activity, complete address of the
applicant, and name and telephone number of the person to contact on
matters related to this application.
6. Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
--``New'' means a new assistance award.
--``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
--``Revision'' means any change in the Federal Government's
financial obligation or contingent liability from an existing
obligation.
9. Name of Federal agency from which assistance is being requested with
this application.
10. Use the Catalog of Federal Domestic Assistance number and title of
the program under which assistance is requested.
11. Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a separate
sheet. If appropriate (e.g., construction or real property projects),
attach a map showing project location. For preapplications, use a
separate sheet to provide a summary description of this project.
12. List only the largest political entities affected (e.g., State,
counties, cities).
13 Self-explanatory.
14. List the applicant's Congressional District and any District(s)
affected by the program or project.
15. Amount requested or to be contributed during the first funding/
budget period by each contributor. Value of in-kind contributions
should be included on appropriate lines as applicable. If the action
will result in a dollar change to an existing award, indicate only the
amount of the change. For decreases, enclose the amounts in
parentheses. If both basic and supplemental amounts are included, show
breakdown on an attached sheet. For multiple program funding, use
totals and show breakdown using same categories as item 15.
16. Applicants should contact the State Single Point of Contact (SPOC)
for Federal Executive Order 12372 to determine whether the application
is subject to the State intergovernmental review process.
17. This question applies to the applicant organization, not the person
who signs as the authorized representative. Categories of debt include
deliquent audit disallowances, loans and taxes.
18. To be signed by the authorized representative of the applicant. A
copy of the governing body's authorization for you to sign this
application as official representative must be on file in the
applicant's office. (Certain Federal agencies may require that this
authorization be submitted as part of the application.)
BILLING CODE 4130-02-M
TN11MY94.001
TN11MY94.002
BILLING CODE 4130-02-C
Instructions for the SF-424A
General Instructions
This form is designed so that application can be made for funds
from one or more grant programs. In preparing the budget, adhere to any
existing Federal grantor agency guidelines which prescribe how and
whether budgeted amounts should be separately shown for different
functions or activities within the program. For some programs, grantor
agencies may require budgets to be separately shown by function or
activity. For other programs, grantor agencies may require a breakdown
by function or activity. Sections A, B, C, and D should include budget
estimates for the whole project except when applying for assistance
which requires Federal authorization in annual or other funding period
increments. In the latter case, Sections A, B, C, and D should provide
the budget for the first budget period (usually a year) and Section E
should present the need for Federal assistance in the subsequent budget
periods. All applications should contain a breakdown by the object
class categories shown in Lines a-k of Section B.
Section A. Budget Summary
Lines 1-4, Columns (a) and (b)
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring a
functional or activity breakdown, enter on Line 1 under Column (a) the
catalog program title and the catalog number in Column (b).
For applications pertaining to a single program requiring budget
amounts by multiple functions or activities, enter the name of each
activity or function on each line in Column (a), and enter the catalog
number in Column (b). For applications pertaining to multiple programs
where none of the programs require a breakdown by function or activity,
enter the catalog program title on each line in Column (a) and the
respective catalog number on each line in Column (b).
For applications pertaining to muiltiple programs where one or more
programs require a breakdown by function or activity, prepare a
separate sheet for each program requiring the breakdown. Additional
sheets should be used when one form does not provide adequate space for
all breakdown of data required. However, when more than one sheet is
used, the first page should provide the summary totals by programs.
Lines 1-4, Columns (c) through (g).
For new applications, leave Columns (c) and (d) blank. For each
line entry in Columns (a) and (b), enter in Columns (e), (f), and (g)
the appropriate amounts of funds needed to support the project for the
first funding period (usually a year).
For continuing grant program applications, submit these forms
before the end of each funding period as required by the grantor
agency. Enter in Columns (c) and (d) the estimated amounts of funds
which will remain unobligated at the end of the grant funding period
only if the Federal grantor agency instructions provide for this.
Otherwise, leave these columns blank. Enter in columns (e) and (f) the
amounts of funds needed for the upcoming period. The amount(s) in
Column (g) should be the sum of amounts in Columns (e) and (f).
For supplemental grants and changes to existing grants, do not use
Columns (c) and (d). Enter in Column (e) the amount of the increase or
decrease of Federal funds and enter in Column (f) the amount of the
increase or decrease of non-Federal funds. In Column (g) enter the new
total budgeted amount (Federal and non-Federal) which includes the
total previous authorized budgeted amounts plus or minus, as
appropriate, the amounts shown in Columns (e) and (f). The amount(s) in
Column (g) should not equal the sum of amounts in Columns (e) and (f).
Line 5--Show the totals for all columns used.
Section B. Budget Categories
In the column headings (1) through (4), enter the titles of the
same programs, functions, and activities shown on Lines 1-4, Column
(a), Section A. When additional sheets are prepared for Section A,
provide similar column headings on each sheet. For each program,
function or activity, fill in the total requirements for funds (both
Federal and non-Federal) by object class categories.
Lines 6a-i--Show the total of Lines 6a to 6h in each column.
Line 6j--Show the amount of indirect cost.
Line 6k--Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total amount in
column (5), Line 6k, should be the same as the total amount shown in
Section A, Column (g), Line 5. For supplemental grants and changes to
grants, the total amount of the increase or decrease as shown in
Columns (1)-(4), Line 6k should be the same as the sum of the amounts
in Section A, Columns (e) and (f) on Line 5.
Line 7--Enter the estimated amount of income, if any, expected to
be generated from this project. Do not add or subtract this amount from
the total project amount. Show under the program narrative statement
the nature and source of income. The estimated amount of program income
may be considered by the federal grantor agency in determining the
total amount of the grant.
Section C. Non-Federal-Resources
Lines 8-11--Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.
Column (a)--Enter the program titles identical to Column (a),
Section A. A breakdown by function or activity is not necessary.
Column (b)--Enter the contribution to be made by the applicant.
Column (c)--Enter the amount of the State's cash and in-kind
contribution if the applicant is not a State or State agency.
Applicants which are a State or State agencies should leave this column
blank.
Column (d)--Enter the amount of cash and in-kind contributions to
be made from all other sources.
Column (e)--Enter totals of Columns (b), (c), and (d).
Line 12--Enter the total for each of Column (b)-(e). The amount in
Column (e) should be equal to the amount on Line 5, Column (f), Section
A.
Section D. Forecasted Cash Needs
Line 13--Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14--Enter the amount of cash from all other sources needed by
quarter during the first year.
Line 15--Enter the totals of amounts on Lines 13 and 14.
Section E. Budget Estimates of Federal Funds Needed for Balance of
the Project
Lines 16-19--Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or activity is
not necessary. For new applications and continuation grant
applications, enter in the proper columns amoun ts of Federal funds
which will be needed to complete the program or project over the
succeeding funding periods (usually in years). This section need not be
completed for revisions (amendments, changes, or supplemental) to funds
for the current year of existing grants.
If more than four lines are needed to list the program titles,
submit additional schedules as necessary.
Line 20--Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21--Use this space to explain amounts for individual direct
object-class cost categories that may appear to be out of the ordinary
or to explain the details as required by the Federal grantor agency.
Line 22--Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during the
funding period, the estimated amount of the base to which the rate is
applied, and the total indirect expense.
Line 23--Provide any other explanations or comments deemed
necessary.
Assurances--Non-Construction Programs
Note: Certain of these assurances may not be applicable to your
project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may
require applicants to certify to additional assurances. If such is
the case, you will be notified.
As the duly authorized representative of the applicant I certify
that the applicant:
1. Has the legal authority to apply for Federal assistance, and the
institutional, managerial and financial capability (including funds
sufficient to pay the non-Federal share of project costs) to ensure
proper planning, management and completion of the project described in
this application.
2. Will give the awarding agency, the Comptroller General of the
United States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books,
papers, or documents related to the award; and will establish a proper
accounting system in accordance with generally accepted accounting
standards or agency directives.
3. Will establish safeguards to prohibit employees from using their
positions for a purpose that constitutes or presents the appearance of
personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time
frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42
U.S.C. Secs. 4728-4763) relating to prescribed standards for merit
systems for programs funded under one of the nineteen statutes or
regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to: (a) Title VI
of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b)
Title IX of the Education Amendments of 1972, as amended (20 U.S.C.
Secs. 1681-1683, and 1685-1686), which prohibits discrimination on the
basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. Sec. 794), which prohibits discrimination on the
basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.C. Secs. 6101-6107), which prohibits discrimination on the
basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Secs. 523 and 527 of the Public Health Service Act of
1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to
confidentiality of alcohol and drug abuse patient records; (h) Title
VIII of the Civil Rights Act of 1968 (42 U.S.C. Sec. 3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing
of housing; (i) any other nondiscrimination provisions in the specific
statute(s) under which application for Federal assistance is being
made; and (j) the requirements of any other nondiscrimination
statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of
Titles II and III of the Uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide
for fair and equitable treatment of persons displaced or whose property
is acquired as a result of Federal or federally assisted programs.
These requirements apply to all interests in real property acquired for
project purposes regardless of Federal participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C.
Secs. 1501-1508 and 7324-7328) which limit the political activities of
employees whose principal employment activities are funded in whole or
in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40 U.S.C.
Sec. 276c and 18 U.S.C. Secs. 874), and the Contract Work Hours and
Safety Standards Act (40 U.S.C. Secs. 327-333), regarding labor
standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster Protection Act of
1973 (P.L. 93-234) which requires recipients in a special flood hazard
area to participate in the program and to purchase flood insurance if
the total cost of insurable construction and acquisition is $10,000 or
more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following (a) institution of environmental
quality control measures under the National Environmental Policy Act of
1969 (P.L. 91-19) and Executive Order (EO) 11514; (b) notification of
violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in
accordance with EO 11988, (e) assurance of project consistency with the
approved State management program developed under the Coastal Zone
Management Act of 1972 (16 U.S.C. Sec. Sec. 1451 et seq.); (f)
conformity of Federal actions to State (Clear Air) Implementation Plans
under Section 176(c) of the Clear Air Act of 1955, as amended (42
U.S.C. Sec. 7401 et seq.); (g) protection of underground sources of
drinking water under the Safe Drinking Water Act of 1974, as amended,
(P.L. 93-523); and (h) protection of endangered species under the
Endangered Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16
U.S.C. Sec. Sec. 1271 et seq.) related to protecting components or
potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with
Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470), EO 11593 (identification and protection of
historic properties), and the Archaeological and Historic Preservation
Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human
subjects involved in research, development, and related activities
supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966
(P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the
care, handling, and treatment of warm blooded animals held for
research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act
(42 U.S.C. Sec. Sec. 4801 et seq.) which prohibits the use of lead
based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations and policies governing this
program.
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Signature of Authorized Certifying Official
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Applicant Organization
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Title
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Date Submitted
Program Narrative Statement
A. New Applications
1. Objectives and need for assistance. Pinpoint any relevant
physical, economic, social, financial, institutional, or other problems
requiring a solution. Demonstrate the need for the assistance and state
the principal and subordinate objectives of the project. Supporting
documentation or other testimonies from concerned interests other than
the applicant may be used. Any relevant data based on planning studies
should be included or footnoted.
2. Results or Benefits Expected. Identify results and benefits to
be derived. The anticipated contribution to policy, practice, theory
and/or research should be indicated.
3. Approach. Outline a plan of action pertaining to the scope and
detail how the proposed work will be accomplished for each project.
Cite factors which might accelerate or decelerate the work and your
reasons for taking this approach as opposed to others. Describe any
unusual features of the project, such as design or technological
innovations, reductions in cost or time, or extraordinary social and
community involvements. Provide for each assistance program
quantitative projections of the accomplishments to be achieved, if
possible. When accomplishments cannot be quantified, list the
activities in chronological order to show the schedule of
accomplishments and their target dates. Identify the kinds of data to
be collected and maintained, and discuss the criteria to be used to
evaluate the results and success of the project. Explain the
methodology that will be used to determine if the needs identified and
discussed are being met and if the results and benefits identified are
being achieved. List each organization, cooperator, consultant, or
other key individuals who will work on the project along with a short
description of the nature of their effort or contribution.
4. Geographic Location. Give a precise location of the project and
area to be served by the proposed project. Maps or other graphic aids
may be attached.
5. If applicable, provide the following information: for research
and demonstration assistance requests, present a biographical sketch of
the program director with the following information: Name, address,
telephone number, background, and other qualifying experience for the
project. Also, list the name, training and background for other key
personnel engaged in the project. Describe the relationship between
this project and other work planned, anticipated, or underway under
Federal assistance.
B. Supplemental Applications
Explain the reason for all requests for supplemental assistance and
justify the need for additional funding. Discuss accomplishments to
date and list in chronological order a schedule of accomplishments,
progress or milestones anticipated with the new funding request. If
there have been significant changes in the project objectives,
location, approach or time delays, explain and justify. For other
requests for changes, or amendments, explain the reason for the
changes(s). If the total budget has been exceeded or if the individual
budget items have changed more than the prescribed limits, explain and
justify the change and its effect on the project.
C. Continuation Applications
Continuation applications need only provide information explaining
significant changes to the original Program Narrative Statement and a
description of accomplishments from the prior budget period.
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U.S. Department of Health and Human Services--Certification Regarding
Drug-Free Workplace Requirements--Grantees Other Than Individuals
By signing and/or submitting this application or grant agreement,
the grantee is providing the certification set out below.
This certification is required by regulations implementing the
Drug-Free Workplace Act of 1988, 45 CFR Part 76, Subpart F. The
regulations, published in the May 25, 1990 Federal Register, require
certification by grantees that they will maintain a drug-free
workplace. The certification set out below is a material representation
of fact upon which reliance will be placed when the Department of
Health and Human Services (HHS) determines to award 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, HHS, in addition to any other remedies available to the
Federal Government, may taken action authorized under the Drug-Free
Workplace Act. False certification or violation of the certification
shall be grounds for suspension of payments, suspension or termination
of grants, or governmentwide suspension or debarment.
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.
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.)
If the workplace identified to HHS 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 above).
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).
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 subparagraph (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 subparagraph (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).
Certification Regarding Debarment, Suspension, and Other Responsibility
Matters--Primary Covered Transactions
By signing and submitting this proposal, the applicant, defined as
the primary participant in accordance with 45 CFR Part 76, certifies to
the best of its knowledge and belief that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions
by any Federal Department or agency;
(b) have not within a 3-year period preceding this proposal been
convicted of or had a civil judgment rendered against them for
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 or otherwise criminally or civilly
charged by a governmental entity (Federal, State, or local) with
commission of any of the offenses enumerated in paragraph (1)(b) of
this certification; and
(d) have not within a 3-year period preceding this application/
proposal had one or more public transactions (Federal, State, or local)
terminated for cause or default.
The inability of a person to provide the certification required
above will not necessarily result in denial of participation in this
covered transaction. If necessary, the prospective participant shall
submit an explanation of why it cannot provide the certification. The
certification or explanation will be considered in connection with the
Department of Health and Human Services (HHS) determination whether to
enter into this transaction. However, failure of the prospective
primary participant to furnish a certification or an explanation shall
disqualify such person from participation in this transaction.
The prospective primary participant agrees that by submitting this
proposal, it will include the clause entitled ``Certification Regarding
Debarment, Suspension, Ineligibility, and Voluntary Exclusion--Lower
Tier Covered Transaction'' provided below without modification in all
lower tier covered transactions and in all solicitations for lower tier
covered transactions.
Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion--Lower Tier Covered Transactions
(To Be Supplied to Lower Tier Participants)
By signing and submitting this lower tier proposal, the prospective
lower tier participant, as defined in 45 CFR Part 76, certifies to the
best of its knowledge and belief that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this
transaction by any federal department or agency.
(b) where the prospective lower tier participant is unable to
certify to any of the above, such prospective participant shall attach
an explanation to this proposal.
The prospective lower tier participant further agrees by submitting
this proposal that it will include this clause entitled ``Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion--Lower Tier Covered Transactions'' without modification in
all lower tier covered transactions and in all solicitations for lower
tier covered transactions.
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and
belief, that:
(1) No Federal Appropriated Funds have been paid or will be paid,
by or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee or any agency, a Member
of Congress, an officer or employee 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 or any agency, a Member of Congress,
an officer or employee of Congress, or an 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.
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Organization
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Authorized Signature Title Date
Note: If Disclosure Forms are required, please contact: Margaret
A. Tolson, Director; Grants Management Division; 330 Independence
Avenue, S.W., Room 4256-COHEN; Washington, D.C. 20201-0001.
[FR Doc. 94-11383 Filed 5-10-94; 8:45 am]
BILLING CODE 4130-02-M
