[Federal Register Volume 60, Number 122 (Monday, June 26, 1995)]
[Notices]
[Pages 32964-32982]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-15585]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
Changing the Culture of Welfare Demonstration
AGENCY: Administration for Children and Families, Department of Health
and Human Services.
ACTION: Announcement of the availability of funds and request for
applications to create and test various cultural change models for
adoption by welfare offices throughout the nation.
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SUMMARY: The Administration for Children and Families (ACF) announces
the availability of Federal funding to participate in intensive joint
planning and development activities that would reinforce the concept of
the temporary nature of welfare, and promote self-sufficiency and
employment. Funding under this announcement is authorized by section
1110 of the Social Security Act governing Social Services Research and
Demonstration activities.
DATES: The closing date for submission of applications is August 25,
1995.
ADDRESSES: Application receipt point: Department of Health and Human
Services, Administration for Children and Families, Division of
Discretionary Grants, 370 L'Enfant Promenade, S.W., 6th Floor, Mailstop
6C-462 Washington, DC 20447, William McCarron, Grants Officer.
Hand delivered applications are accepted during the normal working
hours of 8:00 a.m. to 4:30 p.m., Monday through Friday, on or prior to
the established closing date at: Administration for Children and
Families, Division of Discretionary Grants, 6th Floor, ACF Guard
Station, 901 D Street S.W., Washington DC 20447.
FOR FURTHER INFORMATION CONTACT: Yvonne C. Howard, Project Officer,
Administration for Children and Families, Office of Family Assistance,
370 L'Enfant Promenade, S.W., 5th Floor, Washington, DC 20447.
Telephone (202) 401-4619.
[[Page 32965]] SUPPLEMENTARY INFORMATION: The Administration for
Children and Families (ACF) announces that competing applications are
being accepted for Federal financial assistance to participate in
intensive joint planning and development activities that would
reinforce the concept of the temporary nature of welfare, and promote
self-sufficiency and employment. An initial financial award for 12
months, for up to 8 sites will be made under this announcement. The
Department will fund up to four (4) grantees who will be selected on a
competitive basis to receive second year continuation grants for
implementation of cultural change models. The recipients will be
expected to enter into a cooperative agreement with ACF.
This program announcement consists of four parts. Part I provides
background information about the Changing the Culture of Welfare (CCW)
demonstration. Part II describes the activities supported by this
announcement and application requirements. Part III describes the
application review process. Part IV provides information and
instructions for the development and submission of applications. The
forms to be used for submitting an application follow Part IV.
Part I--Introduction
Current welfare reform proposals emphasize work, responsibility and
the temporary nature of welfare. The focus of the Aid to Families with
Dependent Children (AFDC) program is changing from providing benefits
to preventing welfare dependency. There is growing consensus that AFDC
benefits should be transitional, time-limited assistance, requiring a
goal-oriented partnership between the welfare agency and the AFDC
client. Such a partnership should be designed to help the client
recognize the value of work and construct a plan to enter the job
market and/or training to quickly achieve economic self-sufficiency.
Welfare reform initiatives in the 1980s and 1990s exemplify States'
efforts to seek alternative methods of reducing welfare dependency.
Reform has primarily been sought through waivers of statutory
provisions, seen as barriers to achieving economic independence. In the
welfare debate, another emerging issue has been the need for a radical
culture change in the welfare system and the methods of assistance
provided to the AFDC families.
Part II--Project Design
Purpose
The purpose of the demonstration project is to provide an
opportunity for State/local IV-A agencies who: (1) want to design and
implement cultural change strategies or (2) are already implementing
cultural change strategies successfully but want to further expand
their initiatives, to focus more strongly on work, and make the system
more supportive of self-sufficiency efforts.
State and local welfare agencies are on the front line of the
needed culture change since change must begin where the client meets
the worker. In focusing on what the client needs to become self-
sufficient, workers, supervisors, and administrators must view their
jobs in a broader context. Workers must be empowered to participate in
changing the culture of the welfare office and helping clients move
from dependence to independence.
This culture change may be achieved by a variety of different
approaches, including changes in management style, staff training,
performance measurement and changes to the AFDC and JOBS rules which
are perceived to impede the transition from welfare dependency to
economic self-sufficiency.
Sites will need to create and test cultural change models and look
at the impacts, costs, and benefits of their models. They will need to
demonstrate how the model can be expanded and provide up-front delivery
of services to promote employment opportunities and portray welfare as
a transitional program.
They will need to also demonstrate how the job of the AFDC worker
has changed, or will change, from one of determining eligibility and
payment accuracy to one of financial consultant/customer service agent.
This role includes working with the client to explore options and
alternatives to public assistance, resources available in the community
to meet immediate client needs, demonstrating the financial benefits of
employment vs. receipt of welfare, and marketing (employment
opportunities to the client, and clients to potential employers) etc.
Eligible Applicants
Financial assistance under this announcement is limited to State
and local IV-A agencies. An applications from a local IV-A agency must
be approved by the State IV-A agency.
ACF is interested in providing financial support to IV-A agencies
with experience in, or a demonstrated commitment to changing the
culture of welfare. Examples of cultural change include:
1. Training management and staff, as part of a overall process
redesign geared toward employment and self-sufficiency, including
customer relations training.
2. Improving and modifying technology to support the line worker's
ability to service clients.
3. Implementing performance standards for evaluating staff with an
emphasis on job placement standards as an important criteria.
4. Establishing new criteria and incentives to reward staff
participating in and promoting cultural change activities.
5. Implementing a competency-based case management system.
6. Reclassifying personnel positions to upgrade eligibility
determination staff.
7. Co-locating administrative and client service delivery staff
working on AFDC and JOBS. Combining income maintenance and JOBS
responsibilities in one worker.
8. Implementing more intensive interventions to accommodate harder-
to-serve populations which would include individuals with learning
disabilities and/or developmental disabilities.
9. Establishing with educational institutions such as community
colleges, training institutions and local employers, short term
competency-based training programs linked to actual jobs.
Minimum Requirements for Project Design.
In order to compete successfully in response to this announcement,
the applicant should develop a plan which:
Includes an outline and discussion of current, or planned
culture change activities at the proposed demonstration sites. This
outline should include a description of the specific features/
components and services that are involved with, or impacted by culture
change activities, relevant demographics of the demonstration site, and
the level of agency commitment and community collaboration.
Describes how the applicant proposes to expand existing
culture change strategies and how these strategies will involve a
coordinated, integrated approach among, at minimum, AFDC/JOBS staff.
Demonstrates how this model will increase the
experiential/research information we now have of what AFDC clients need
to become self-sufficient.
Demonstrates how the model (or parts thereof) can be
replicated in other localities. [[Page 32966]]
Includes methods for measuring the effects of the
demonstration on AFDC/JOBS participants, e.g. increased participation,
employment/earnings; reduced welfare dependency.
Describes how a cost/benefit analysis will compare the
direct and indirect costs with the financial and non-financial benefits
of the program from the point of view of the participants; the
government (Federal, State, and local); and the taxpayer.
Includes the applicant's approach for providing assistance
and training to State and county demonstration project staff, as
needed.
Provides information about other (State, local, community)
resources the site will use to support this effort, including financial
support (if any) for the demonstration, in addition to Federal funding.
Provides for travel to Washington, DC (2 times) and one
site visit to another project for up to three people.
In recognition of the scope of the initiative, the potential
difficulty in successfully implementing and operationalizing agency
culture change, and the significance of the initiative for public
policy, ACF has determined that a close, cooperative working
relationship between the ACF and the selected States will greatly
further the public interest. Therefore, the awards made under this
announcement will be cooperative agreements between ACF and the
selected State IV-A agencies. It is anticipated that ACF will be
involved in the performance of the initiative in the following manner:
ACF, working in cooperation with the State, will review
and comment on the agency's cultural change strategies to ensure that
the project meets specified goals and objectives.
ACF will conduct site visits, teleconferences, and
meetings, as appropriate, to provide technical assistance.
ACF will facilitate information sharing and discussions
across sites.
The above-cited areas of involvement are illustrative of the
anticipated level of Federal involvement with the selected States in
the initiative. The exact activities will be detailed in the
Cooperative Agreement which will be developed with each selected State.
Project Duration
The length of the project should not exceed two years (24 months).
This announcement is soliciting applications for two-year projects.
Awards, on a competitive basis, will be for an initial one-year budget
period for the design and planning of the project. Up to eight
recipients of this initial award will compete among themselves for the
four (4) continuation awards. Four awards for project implementation,
beyond the one-year budget period but within the two-year project
period will be entertained, subject to availability of funds,
satisfactory progress of the recipient, and a determination that
continued funding would be in the best interest of the Government.
Federal Share of the Project
The maximum Federal share of the Project is not to exceed $1.8
million for the two-year project period, subject to the availability of
funds. The maximum Federal share for the first year budget period will
be $400,000 divided among up to eight recipients. The maximum Federal
share for the second year continuation grants will be $1.4 million
divided among four recipients.
Matching Requirement
Applicants must provide at least five (5) percent of the total cost
of the project. The total approved cost of the project is the sum of
the ACF share and the non-Federal share. The non-Federal share may be
met by cash or in-kind contributions, although applicants are
encouraged to meet their match requirements through cash contributions.
Therefore, a project requesting $50,000 in Federal funds must include a
match of at least $2,632 (i.e., 5 percent of the sum of the Federal and
the non-Federal cost of the project). The successful applicant's match
must be met by the completion of the project period.
The recipient will be required to provide the agreed upon non-
Federal share, even if it exceeds the required match stated above.
Therefore, applicants should ensure that any amount proposed as
matching funds is committed to the project prior to inclusion in its
budget.
Anticipated Number of Projects to be Funded
Up to eight projects will be funded under this announcement.
Part III--The Review Process
A. Review Process and Funding Decisions
Timely applications from eligible applicants will be reviewed and
scored competitively. Reviewers will use the evaluation criteria listed
below to review and score the application.
In addition ACF may refer applications to other Federal or non-
Federal funding sources when it is determined to be in the best
interest of the Federal Government or the applicant. It may also
solicit comments from ACF Regional Office staff, other Federal
agencies, interested foundations and national organizations. These
comments along with those of the reviewers will be considered by ACF in
making the funding decision.
In making a funding decision, ACF may give preference to
applications which reflect experience in working with the cultural
change strategies since such experience on the part of a recipient has
the potential to substantially improve the development of a culture
change model.
B. Evaluation Criteria
Using the evaluation criteria below, reviewers will review and
score each application. Applicants should insure that they address each
minimum requirement listed above.
Reviewers will determine the strengths and weaknesses of each
application in terms of the appropriate evaluation criteria listed
below, provide comments, and assign numerical scores. The point value
following each criterion heading indicates the maximum numerical weight
that each criterion may be given in the review process.
Review Criteria
(1) Knowledge of Changing the Culture of Welfare (25 points)
The applicant's proposal should demonstrate a good understanding of
the project design and the tasks and objectives involved in the
project. The application should provide: (a) evidence of organizational
experience in changing the culture of welfare and/or (b) evidence of
commitment to planning and implementing agency cultural change
activities. The discussion should also reflect a clear understanding of
``culture'' change and the current emphasis on work and responsibility
and transitional benefits.
(2) Approach and Project Design (30 points)
The application should include: (a) an outline of the project
design which takes into account specific features the applicant wishes
to address, the objectives, component(s) and services that will be
impacted by the culture change strategies; (b) a description of how the
applicant will involve agency staff (AFDC and JOBS) in the planning
process, which staff (front-line worker/management etc.), and the level
of staff involvement; and (c) the applicant's approach for providing
assistance and training to agency staff to enable their full
participation in the planning process. [[Page 32967]]
(3) Public--Private Partnerships (15 points)
In order to maximize the potential resources of the community to
provide options and alternatives to the public welfare system, the
applicant should provide evidence of coordination and commitments by
public, private, non-profit, community organizations and businesses to
support changing the culture of welfare.
(4) Methodology (5 points)
The application should describe proposed methodology for measuring
the effects of the planned demonstration on AFDC/JOBS participants and
the extent to which the experiential/research knowledge will be
increased.
(5) Staff Skills and Responsibilities (20 points)
It has been our experience that in order for demonstrations of this
scope to be successful, the support and commitment of the
administrators at the highest levels of the agency are necessary.
Demonstrations such as this are under tight time constraints and
require innovation and flexibility. For example, it may be necessary
from time to time to provide exceptions to normal administrative
processes or to establish expedited processes. Thus the support and
commitment of senior official to accomplish the many tasks involved is
critical. The application should discuss this issue and indicate the
level of commitment to the demonstration which is proposed. The
application should list key individuals who will work on the project
along with a short description of the nature of their contribution.
Summarize the background and experience of the project director and key
project staff.
(6) Budget Appropriateness (5 points)
The application should demonstrate that the project's costs are
reasonable in view of the anticipated results and benefits. Applicants
may refer to the budget information presented in the Standard Forms 424
and 424A.
Part IV--Instructions for the Development and Submission of
Applications
This part contains information and instructions for submitting
applications in response to this announcement. Application forms are
provided as part of this announcement along with a checklist for
assembling an application package.
A. Required Notification of the State Single Point of Contact
This program announcement is covered under Executive Order 12372,
Intergovernmental Review of Federal Programs, and 45 CFR Part 100,
Intergovernmental Review of Department of Health and Human Services
Program and Activities. Under the Order, States may design their own
processes for reviewing and commenting on proposed Federal assistance
under covered programs.
All States and Territories except Alabama, Alaska, Colorado,
Connecticut, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana,
Nebraska, Oklahoma, Oregon, Virginia, Pennsylvania, South Dakota,
Washington, American Samoa and Palau have elected to participate in the
Executive Order process and have established Single Points of Contact
(SPOCs), listed at the end of this announcement. Applicants from these
nineteen jurisdictions need take no action regarding E.O. 12372.
Applicants for projects to be administered by Federally-recognized
Indian Tribes are also exempt from the requirements of E.O. 12372.
Otherwise, applicants should contact their SPOCs as soon as possible to
alert them of the prospective applications and receive any necessary
instructions. Applicants must submit any required material to the SPOCs
as soon as possible so that the program office can obtain and review
SPOC comments as part of the award process. It is imperative that the
applicant submit all required materials, if any, to the SPOC and
indicate the date of this submittal (or the date of contact if no
submittal is required) on the Standard Form 424, item 16a.
Under 45 CFR 100.8(a)(2), a SPOC has 60 days from the application
deadline to comment on proposed new or competing continuation awards.
SPOCs are encouraged to eliminate the submission of routine
endorsements as official recommendations. Additionally, SPOCs are
requested to clearly differentiate between mere advisory comments and
those official State process recommendations which may trigger the
``accommodate or explain'' rule.
When comments are submitted directly to ACF, they should be
addressed to: Department of Health and Human Services, Administration
for Children and Families, Division of Discretionary Grants, 370
L'Enfant Promenade, S.W., 6th Floor, Mailstop 6C-462, Washington, D.C.
20447.
Refer to the beginning of this announcement under the heading
ADDRESSES, for hand delivered applications.
B. Deadline for Submittal of Applications
The closing date for submittal of applications under this program
announcement is found at the beginning of this announcement under the
heading DATES. Applications shall be considered as meeting the
announced deadline if they are either:
1. Received on or before the deadline date at the receipt point
specified in this program announcement, or
2. Sent on or before the deadline date and received by ACF in time
for the independent review. Applicants are cautioned to request a
legibly dated receipt from a commercial carrier or U.S. Postal Service.
Private metered postmarks shall not be acceptable as proof of timely
mailing.
Late Applications: Applications which do not meet the criteria in 1
and 2 above are considered late applications. ACF shall notify each
late applicant that its application will not be considered in the
current competition.
Extension of Deadlines: ACF may extend the deadline for all
applicants because of acts of God, such as floods, hurricanes, etc., or
when there is widespread disruption of mails. However, if ACF does not
extend the deadline for all applicants, it will not extend the deadline
for any applicants.
C. Instructions for Preparing the Application
In order to assist applicants in completing the application, the
Standard Forms 424 and 424A, required certifications, and a list of
SPOCs have been included at the end of Part IV of this announcement.
Please reproduce single-sided copies of these forms from the reprinted
forms and type your information onto the copies.
Please prepare your application in accordance with the following
instructions:
1. SF 424 Page 1, Application Cover Sheet
Please read the following instructions before completing the
application cover sheet. An explanation of each item is included.
Complete only the items specified.
Item 1. Type of Submission--Non-Construction.
Item 2. Date Submitted and Applicant Identifier--Date application
is submitted to ACF and applicant's own internal control number, if
applicable.
Item 3. Date Received By State--State use only (if applicable).
Item 4. Date Received by Federal Agency--Leave blank.
[[Page 32968]]
Item 5. Applicant Information.
Legal Name--Enter the legal name of applicant organization. For
applications developed jointly, enter the name of the lead organization
only. There must be a single applicant for each application.
Organizational Unit--Enter the name of the primary unit within the
applicant organization which will actually carry out the project
activity. If this is the same as the applicant organization, leave the
organizational unit blank.
Address--Enter the complete address that the organization actually
uses to receive mail, since this is the address to which all
correspondence will be sent. Do not include both street address and
P.O. box number unless both must be used in mailing.
Name and telephone number of the person to be contacted on matters
involving this application (give area code)--Enter the full name and
telephone number of a person who can respond to questions about the
application. This person should be accessible at the address given.
Item 6. Employer Identification Number (EIN)--Enter the employer
identification number of the applicant organization, as assigned by the
Internal Revenue Service, including, if known, the Central Registry
System suffix.
Item 7. Type of Applicant--Self-explanatory.
Item 8. Type of Application--New.
Item 9. Name of Federal Agency--DHHS/ACF.
Item 10. Catalog of Federal Domestic Assistance Number--93.647.
Item 11. Descriptive Title of Applicant's Project--Changing the
Culture of Welfare.
Item 12. Areas Affected by Project--Leave Blank.
Item 13. Proposed Project--Enter the desired start date for the
project and projected completion date. The project period must begin no
later than September 30, 1995.
Item 14. Congressional District of Applicant/Project--Enter the
number of the Congressional district where the applicant's principal
office is located.
Items 15. Estimated Funding Levels--In completing 15a through 15f,
the dollar amounts entered should reflect the total amount requested
for the first 12-month budget period.
Item 15a. Enter the amount of Federal funds requested in accordance
with the preceding paragraph. This amount should be no greater than the
maximum amount available under this announcement for the first 12-month
budget period.
Items 15b-e. Enter the amount(s) of funds from non-Federal sources
that will be contributed to the proposed project. Items b-e are
considered cost-sharing or matching funds.
Item 15f. Enter the estimated amount of income, if any, expected to
be generated from the proposed project. Do not add or subtract this
amount from the total project amount entered under item 15g. Describe
the nature, source and anticipated use of this income in the Project
Narrative Statement.
Item 15g. Enter the sum of items 15a-15e.
Item 16a. Is Application Subject to Review By State Executive Order
12372 Process?--Check Yes if your State participates in the E.O. 12372
process. Enter the date the application was made available to the State
for review. Select the appropriate SPOC from the listing provided at
the end of Part IV. The review of the application is at the discretion
of the SPOC.
Item 16b. Is Application Subject to Review By State Executive Order
12372 Process?--Check No if the program has not been selected by State
for review.
Item 17. Is the Applicant Delinquent on any Federal Debt?--Check
the appropriate box. This question applies to the applicant
organization, not the person who signs as the authorized
representative. Categories of debt include audit disallowances, loans
and taxes.
Item 18. To the best of my knowledge and belief, all data in this
application/preapplication are true and correct. The document has been
duly authorized by the governing body of the applicant and the
applicant will comply with the attached assurances if the assistance is
awarded.--To be signed by the authorized representative of the
applicant. A copy of the governing body's authorization for signature
of this application by this individual as the official representative
must be on file in the applicant's office, and may be requested from
the applicant.
Item 18a-c. Typed Name of Authorized Representative, Title,
Telephone Number--Enter the name, title and telephone number of the
authorized representative of the applicant organization.
Item 18d. Signature of Authorized Representative--Signature of the
authorized representative named in Item 18a. At least one copy of the
application must have an original signature. Use colored ink (not
black) so that the original signature is easily identified.
Item 18e. Date Signed--Enter the date the application was signed by
the authorized representative.
2. SF 424A--Budget Information--Non-Construction Programs
This is a form used by many Federal agencies. For this application,
Sections A, B, C, and E are to be completed. Sections D and F do not
need to be completed.
Section A--Budget Summary. Line 1:
Column (a): Enter Changing the Culture of Welfare;
Column (b): Enter 93.647.
Columns (c) and (d): Leave blank.
Columns (e), (f) and (g): Enter the appropriate amounts needed to
support the project for the first budget period.
Section B--Budget Categories. This budget should include the
Federal as well as non-Federal funding for the proposed project for the
first 12-month budget period. The budget should relate to item 15g,
total funding, on the SF 424. Under column (5), enter the total
requirements for funds (Federal and non-Federal) by object class
category.
A separate budget justification should be included to explain fully
and justify items, as indicated below. The types of information to be
included in the justification are indicated under each category. The
budget justification should immediately follow the second page of the
SF 424A.
Personnel--Line 6a. Enter the total costs of salaries and wages of
applicant/grantee staff. Do not include the costs of consultants, which
should be included on line 6h, Other.
Justification: Identify the staff, if known, specify. Specify by
title or name the percentage of time allocated to the project, the
individual annual salaries, and the cost to the project (both Federal
and non-Federal) of the organization's staff who will be working on the
project.
Fringe Benefits--Line 6b. Enter the total costs of fringe benefits.
Justification: Provide a break-down of amounts and percentages that
comprise fringe benefit costs, such as health insurance, FICA,
retirement insurance, etc.
Travel--6c. 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, which should be included
on Line 6h, Other.
Justification: Include the name(s) of traveler(s), total number of
trips, destinations, length of stay, transportation costs and
subsistence allowances.
Equipment--Line 6d. Enter the total costs of all equipment to be
acquired by the project. For grants governed by the administrative
requirements of 45 CFR part 74, equipment means an article of
[[Page 32969]] nonexpendable tangible personal property having an
acquisition cost of $5000 or more per unit and a useful life of more
than one year. For grants governed by the administrative requirements
of 45 CFR part 92, equipment is tangible, nonexpendable personal
property having a useful life of more than one year and an acquisition
cost of $5,000 or more per unit.
Justification: Equipment to be purchased with Federal funds must be
justified. The equipment must be required to conduct the project, and
the applicant organization or its subgrantees must not have the
equipment or a reasonable facsimile available to the project. The
justification also must contain plans for future use or disposal of the
equipment after the project ends.
Supplies--Line 6e. Enter the total costs of all tangible expendable
personal property (supplies) other than those included on Line 6d.
Justification: Specify general categories of supplies and their
costs.
Contractual--Line 6f. Enter the total costs of all contracts,
including procurement contracts (except those which belong on other
lines such as equipment, supplies, etc.) and contracts with secondary
recipient organizations. Also include any contracts with organizations
for the provision of technical assistance. Do not include payments to
individuals on this line.
Justification: Attach a list of contractors, indicating the names
of the organizations, the purposes of the contracts, and the estimated
dollar amounts of the awards as part of the budget justification.
Whenever the applicant/grantee intends to delegate part or all of the
program to another agency, the applicant/grantee must complete this
section (Section B, Budget Categories) for each delegate agency by
agency title, along with the supporting information. The total cost of
all such agencies will be part of the amount shown on Line 6f. Provide
backup documentation identifying the name of contractor, purpose of
contract, and major cost elements.
Construction--Line 6g. Not applicable. New construction is not
allowable.
Other--Line 6h. Enter the total of all other costs. Where
applicable, such costs 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 costs,
including tuition and stipends; training service costs, including wage
payments to individuals and supportive service payments; and staff
development costs. Note that costs identified as miscellaneous and
honoraria are not allowable.
Justification: Specify the costs included.
Total Direct Charges--Line 6i. Enter the total of Lines 6a through
6h.
Indirect Charges--6j. Enter the total amount of indirect charges
(costs). If no indirect costs are requested, enter none. Local and
State governments should enter the amount of indirect costs determined
in accordance with HHS requirements. When an indirect cost rate is
requested, these costs are included in the indirect cost pool and
should not be charged again as direct costs to the grant. In the case
of training grants to other than State or local governments (as defined
in title 45, Code of Federal Regulations, part 74), the Federal
reimbursement of indirect costs will be limited to the lesser of the
negotiated (or actual) indirect cost rate or 8 percent of the amount
allowed for direct costs, exclusive of any equipment charges, rental of
space, tuition and fees, post-doctoral training allowances, contractual
items, and alterations and renovations.
Justification: Enclose a copy of the indirect cost rate agreement,
if applicable.
Total--Line 6k. Enter the total amounts of lines 6i and 6j.
Program Income--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.
Justification: Describe the nature, source, and anticipated use of
program income in the Program Narrative Statement.
Section C--Non-Federal Resources. This section summarizes the
amounts of non-Federal resources that will be applied to the grant. On
lines 8-11, list estimates for each projected budget period within the
total project period (if an additional line is needed, use line 23 and
label it appropriately). Enter total amounts on line 12.
In-kind contributions are defined in title 45 of the Code of
Federal Regulations, Part 74.2., as the value of non-cash contributions
provided by non-Federal third parties. Third party in-kind
contributions may be in the form of real property, equipment, supplies
and other expendable property, and the value of goods and services
directly benefiting and specifically identifiable to the project or
program.
Justification: Describe third party in-kind contributions, if
included.
Section D--Forecasted Cash Needs. Not applicable.
Section E--Budget Estimate of Federal Funds Needed For Balance of
the Project. On lines 16-19, list estimates for Federal assistance
required for future budget periods within the total project period.
List estimated total amounts on line 20.
Section F--Other Budget Information. Not applicable.
3. Program Narrative Statement
The Program Narrative Statement should be clear, concise, and
address the specific requirements mentioned under Part II. The
narrative should also provide information concerning how the
application meets the evaluation criteria using the following headings:
(a) Knowledge of Changing the Culture of Welfare;
(b) Approach and Project Design;
(c) Public-Private Partnerships;
(d) Methodology;
(e) Staff Skills and Responsibilities;
(f) Budget Appropriateness.
The specific information to be included under each of these
headings is described in section B of Part III--Evaluation Criteria.
The narrative should be typed double-spaced. All pages of the
narrative (including charts, references, footnotes, tables, maps,
exhibits, etc.) must be sequentially numbered, beginning with
Organizational Experience. The length of the application, including the
application forms and all attachments, should not exceed 125 pages.
4. Assurances/Certifications
Applicants are required to file an SF 424B, Assurances--Non-
Construction Programs, and the Certification Regarding Lobbying. Both
must be signed and returned with the application. In addition,
applicants must certify their compliance with: (1) Drug-Free Workplace
Requirements; and (2) Debarment and Other Responsibilities. These
certifications are self-explanatory. Copies of these assurances and
certifications are reprinted at the end of this announcement and should
be reproduced, as necessary. A duly authorized representative of the
applicant organization must certify that the applicant is in compliance
with these assurances and certifications. A signature on the SF 424
indicates compliance with Drug-Free Workplace and Debarment notices and
Public Law 103-227, Part C--Environmental Tobacco Smoke, also known as
the Pro-Children Act of 1994. [[Page 32970]]
D. Checklist for a Complete Application
The checklist below is for your use to ensure that your application
package has been properly prepared.
--One original application, signed and dated, plus two copies.
--Complete application length should not exceed 125 pages.
--A complete application consists of the following items in this order:
Application for Federal Assistance (SF 424);
A completed SPOC certification with the date of SPOC
contact entered in line 16, page 1 of the SF 424 if applicable;
Budget Information--Non-construction programs (SF 424A);
Budget Justification for SF 424A Section B--Budget
Categories;
Letter from the Internal Revenue Service to prove
nonprofit status, if necessary;
Copy of the applicant's approved indirect cost rate
agreement, if appropriate;
Program Narrative Statement (See Part III, Section C);
Assurances--Non-construction programs (SF 424B); and
Certification Regarding Lobbying.
E. Submitting the Application
Each application package must include an original and two copies of
the complete application. Each copy should be stapled securely. All
pages of the narrative (including charts, tables, maps, exhibits, etc.)
must be sequentially numbered. In order to facilitate handling, please
do not use covers, binders, or tabs.
Applicant should include a self-addressed, stamped acknowledgment
card. All applicants will be notified automatically about the receipt
of their application.
Catalog of Federal Domestic Assistance 93.647.
Dated: May 22, 1995.
Lavinia Limon,
Director, Office of Family Assistance.
BILLING CODE 4184-01-P
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BILLING CODE 4184-01-C
[[Page 32972]] 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) and applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing
award, enter present Federal identifier number. If for a new
project, leave blank.
5. Legal name of applicant, name of primary organizational unit
which will undertake the assistance activity, complete address of
the applicant, and name and telephone number of the person to
contact on matters related to this application.
6. Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
--``New'' means a new assistance award.
--``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
--``Revision'' means any change in the Federal Government's
financial obligation or contingent liability from an existing
obligation.
9. Name of Federal agency from which assistance is being
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number and
title of the program under which assistance is requested.
11. Enter a brief descriptive title of the project. If more than
one program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real property
projects), attach a map showing project location. For
preapplications, use a separate sheet to provide a summary
description of this project.
12. List only the largest political entities affected (e.g.,
State, counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and any
District(s) affected by the program or project.
15. Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as applicable.
If the action will result in a dollar change to an existing award,
indicate only the amount of the change. For decreases, enclose the
amounts in parentheses. If both basic and supplemental amounts are
included, show breakdown on an attached sheet. For multiple program
funding, use totals and show breakdown using same categories as item
15.
16. Applicants should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine whether the
application is subject to the State intergovernmental review
process.
17. This question applies to the applicant organization, not the
person who signs as the authorized representative. Categories of
debt include delinquent audit disallowances, loans and taxes.
18. To be signed by the authorized representative of the
applicant. A copy of the governing body's authorization for you to
sign this application as official representative must be on file in
the applicant's office. (Certain Federal agencies may require that
this authorization be submitted as part of the application.)
BILLING CODE 4184-01-P
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BILLING CODE 4184-01-C
[[Page 32975]] 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 multiple programs where one or
more programs require a breakdown by function or activity, prepare a
separate sheet for each program requiring the breakdown. Additional
sheets should be used when one form does not provide adequate space
for all breakdown of data required. However, when more than one
sheet is used, the first page should provide the summary totals by
programs.
Lines 1-4, Columns (c) through (g)
For new applications, leave 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 amounts(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 totals of Lines 6a to 6h in each column.
Line 6j--Show the amount of indirect cost.
Line 6k--Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total amount
in column (5), Line 6k, should be the same as the total amount shown
in Section A, Column (g), Line 5. For supplemental grants and
changes to grants, the total amount of the increase or decrease as
shown in Columns (1)-(4), Line 6k should be the same as the sum of
the amounts in Section A, Columns (e) and (f) on Line 5.
Line 7--Enter the estimated amount of income, if any, expected
to be generated from 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 Columns (b)-(e). The amount
in column (e) should be equal to the amount on Line 5, Column (f),
Section A.
Section D. Forecasted Cash Needs
Line 13--Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14--Enter the amount of cash from all other sources needed
by quarter during the first year.
Line 15--Enter the totals of amounts on Lines 13 and 14.
Section E. Budget Estimates of Federal Funds Needed for Balance of the
Project
Line 16-19--Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or activity
is not necessary. For new applications and continuation grant
applications, enter in the proper columns amounts of Federal funds
which will be needed to complete the program or project over the
succeeding funding periods (usually in years). This section need not
be completed for revisions (amendments, changes, or supplements) to
funds for the current year of existing grants.
If more than four lines are needed to list the program titles,
submit additional schedules as necessary.
Line 20--Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21--Use this space to explain amounts for individual direct
object-class cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal
grantor agency.
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 [[Page 32976]] accordance with
generally accepted accounting standards or agency directive.
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. 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 (2) U.S.C.
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. 794), which prohibits discrimination on the basis
of handicaps; (d) the Age Discrimination Act of 1975, as amended (42
U.S.C. 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) 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. 3601 et seq.),
as amended, relating to non-discrimination 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.
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. 276a to 276a-7), the Copeland Act (40 U.S.C.
276c and 18 U.S.C. 874), and the Contract Work Hours and Safety
Standards Act (40 U.S.C. 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 if $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order
(EO) 11514; (b) notification of violating facilities pursuant to EO
11738; (c) protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance with EO
11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C 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. 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 Wild and Scenic Rivers Act of 1968 (16
U.S.C. 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. 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.
----------------------------------------------------------------------
Signature of Authorized Certifying Official
----------------------------------------------------------------------
Applicant Organization
----------------------------------------------------------------------
Title
----------------------------------------------------------------------
Date Submitted
Executive Order 12373--State Single Points of Contact
Arizona
Mrs. Janice Dunn, ATTN: Arizona State Clearinghouse, 3800 N. Central
Avenue, 14th Floor, Phoenix, Arizona 85012, Telephone (602) 280-1315
Arkansas
Tracie L. Copeland, Manager, State Clearinghouse, Office of
Intergovernmental Services, Department of Finance and
Administration, P.O. Box 3278, Little Rock, Arkansas 72203,
Telephone (501) 682-1074
California
Glenn Stober, Grants, Coordinator, Office of Planning and Research,
1400 Tenth Street, Sacramento, California 95814, Telephone (916)
323-7480
Delaware
Ms. Francine Booth, State Single Point of Contact, Executive
Department, Thomas Collins Building, Dover, Delaware 19903,
Telephone (302) 736-3326
District of Columbia
Rodney T. Hallman, State Single Point of Contact, Office of Grants
Management and Development, 717 14th Street, N.W., Suite 500,
Washington, D.C. 20005, Telephone (202) 727-6551
Florida
Florida State Clearinghouse, Intergovernmental Affairs Policy Unit,
Executive Office of the Governor, Office of Planning and Budgeting,
The Capitol, Tallahassee, Florida 32399--0001, Telephone (904) 488-
8441
Georgia
Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse,
254 Washington Street, S.W., Atlanta, Georgia 30334, Telephone (404)
656-3855
Illinois
Steve Klokkenga, State Single Point of Contact, Office of the
Governor, 107 Stratton Building, Springfield, Illinois 62706,
Telephone (217) 782-1671
Indiana
Jean S. Blackwell, Budget Director, State Budget Agency, 212 State
House, Indianapolis, Indiana 46204, Telephone (317) 232-5610
Iowa
Mr. Steven R. McCann, Division of Community Progress, Iowa
Department of Economic Development, 200 East Grand Avenue, Des
Moines, Iowa 50309, Telephone (515) 281-3725 [[Page 32977]]
Kentucky
Ronald W. Cook, Office of the Governor, Department of Local
Government, 1024 Capitol Center Drive, Frankfort, Kentucky 40601,
Telephone (502) 564-2382
Maine
Ms. Joyce Benson, State Planning Office, State House Station #38,
Augusta, Maine 04333, Telephone (207) 289-3261
Maryland
Ms. Mary Abrams, Chief, Maryland State Clearinghouse, Department of
State Planning, 301 West Preston Street, Baltimore, Maryland 21201-
2365, Telephone (301) 225-4490
Massachusetts
Karen Arone, State Clearinghouse, Executive Office of Communities
and Development, 100 Cambridge Street, Room 1803, Boston,
Massachusetts 02202, Telephone (617) 727-7001
Michigan
Richard S. Pastula, Director, Michigan Department of Commerce,
Lansing, Michigan 48909, Telephone (517) 373-7356
Mississippi
Ms. Cathy Mallette, Clearinghouse Officer, Office of Federal Grant
Management and Reporting, 301 West Pearl Street, Jackson,
Mississippi 39203, Telephone (601) 960-2174
Missouri
Ms. Lois Pohl, Federal Assistance Clearinghouse, Office of
Administration, P.O. Box 809, Room 430, Truman Building, Jefferson
City, Missouri 65102, Telephone (314) 751-4834
Nevada
Department of Administration, State Clearinghouse, Capitol Complex,
Carson City, Nevada 89710, Telephone (702) 687-4065, Attention: Ron
Sparks, Clearinghouse Coordinator
New Hampshire
Mr. Jeffrey H. Taylor, Director, New Hampshire Office of State
Planning, Attn: Intergovernmental Review, Process/James E. Bieber,
2\1/2\ Beacon Street, Concord, New Hampshire 03301, Telephone (603)
271-2155
New Jersey
Gregory W. Adkins, Acting Director, Division of Community Resources,
N.J. Department of Community Affairs, Trenton, New Jersey 08625-
0803, Telephone (609) 292-6613
Please direct correspondence and questions to: Andrew J.
Jaskolka, State Review Process, Division of Community Resources, CN
814, Room 609, Trenton, New Jersey 08625-0803, Telephone (609) 292-
9025.
New Mexico
George Elliott, Deputy Director, State Budget Division, Room 190,
Bataan Memorial Building, Santa Fe, New Mexico 87503, Telephone
(505) 827-3640, FAX (505) 827-3006
New York
New York State Clearinghouse, Division of the Budget, State Capitol,
Albany, New York 12224, Telephone (518) 474-1605
North Carolina
Mrs. Chrys Baggett, Director, Office of the Secretary of Admin.,
N.C. State Clearinghouse, 116 W. Jones Street, Raleigh, North
Carolina 27603-8003, Telephone (919) 733-7232
North Dakota
N.D. Single Point of Contact, Office of Intergovernmental
Assistance, Office of Management and Budget, 600 East Boulevard
Avenue, Bismarck, North Dakota 58505-0170, Telephone (701) 224-2094
Ohio
Larry Weaver, State Single Point of Contact, State/Federal Funds
Coordinator, State Clearinghouse, Office of Budget and Management,
30 East Broad Street, 34th Floor, Columbus, Ohio 43266-0411,
Telephone (614) 466-0698
Rhode Island
Mr. Daniel W. Varin, Associate Director, Statewide Planning Program,
Department of Administration, Division of Planning, 265 Melrose
Street, Providence, Rhode Island 02907, Telephone (401) 277-2656
Please direct correspondence and questions to: Review
Coordinator, Office of Strategic Planning.
South Carolina
Omeagia Burgess, State Single Point of Contact, Grant Services,
Office of the Governor, 1205 Pendleton Street, Room 477, Columbia,
South Carolina 29201, Telephone (803) 734-0494
Tennessee
Mr. Charles Brown, State Single Point of Contact, State Planning
Office, 500 Charlotte Avenue, 309 John Sevier Building, Nashville,
Tennessee 37219, Telephone (615) 741-1676
Texas
Mr. Thomas Adams, Governor's Office of Budget and Planning, P.O. Box
12428, Austin, Texas 78711, Telephone (512) 463-1778
Utah
Utah State Clearinghouse, Office of Planning and Budget, ATTN:
Carolyn Wright, Room 116 State Capitol, Salt Lake City, Utah 84114,
Telephone (801) 538-1535
Vermont
Mr. Bernard D. Johnson, Assistant Director, Office of Policy
Research & Coordination, Pavilion Office Building, 109 State Street,
Montpelier, Vermont 05602, Telephone (802) 828-3326
West Virginia
Mr. Fred Cutlip, Director, Community Development Division, West
Virginia Development Office, Building #6, Room 553, Charleston, West
Virginia 25305, Telephone (304) 348-4010
Wisconsin
Mr. William C. Carey, Federal/State Relations, Wisconsin Department
of Administration, 101 South Webster Street, P.O. Box 7864, Madison,
Wisconsin 53707, Telephone (608) 266-0267
Wyoming
Sheryl Jeffries, State Single Point of Contact, Herschler Building,
4th Floor, East Wing, Cheyenne, Wyoming 82002, Telephone (307) 777-
7574
Guam
Mr. Michael J. Reidy, Director, Bureau of Budget and Management
Research, Office of the Governor, P.O. Box 2950, Agana, Guam 96910,
Telephone (671) 472-2285
Northern Mariana Islands
State Single Point of Contact, Planning and Budget Office, Office of
the Governor, Saipan, CM, Northern Mariana Islands 96950
Puerto Rico
Norma Burgos/Jose H. Caro, Chairman/Director, Puerto Rico Planning
Board, Minillas Government Center, P.O. Box 41119, San Juan, Puerto
Rico 00940-9985, Telephone (809) 727-4444
Virgin Islands
Jose L. George, Director, Office of Management and Budget, #41
Norregade Emancipation Garden Station, Second Floor, Saint Thomas,
Virgin Islands 00802.
Please direct correspondence to: Linda Clarke, Telephone (809)
774-0750.
BILLING CODE 4184-01-P
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[[Page 32979]]
[GRAPHIC][TIFF OMITTED]TN26JN95.006
BILLING CODE 4184-01-C
[[Page 32980]] 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 believe 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 of any
agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification
of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant,
loan or cooperative agreement, the undersigned shall complete and
submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in
accordance with its instructions.
(3) The undersigned shall require that the language of this
certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and
belief, that:
If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with this
commitment providing for the United States to insure or guarantee a
loan, the undersigned shall complete and submit Standard Form-LLL,
``Disclosure Form to Report Lobbying,'' in accordance with its
instructions.
Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required statement shall
be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
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Signature
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Title
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Organization
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Date
BILLING CODE 4184-01-P
[[Page 32981]]
[GRAPHIC][TIFF OMITTED]TN26JN95.004
BILLING CODE 4184-01-C
[[Page 32982]] Certification Regarding Environmental Tobacco Smoke
Public Law 103-227, Part C--Environmental Tobacco Smoke, also
known as the Pro-Children Act of 1994 (Act), requires that smoking
not be permitted in any portion of any indoor routinely owned or
leased or contracted for by an entity and used routinely or
regularly for provision of health, day care, education, or library
services to children under the age of 18, if the services are funded
by Federal programs either directly or through State or local
governments, by Federal grant, contract, loan, or loan guarantee.
The law does not apply to children's services provided in private
residences, facilities funded solely by Medicare or Medicaid funds,
and portions of facilities used for inpatient drug or alcohol
treatment. Failure to comply with the provisions of the law may
result in the imposition of a civil monetary penalty of up to $1000
per day and/or the imposition of an administrative compliance order
on the responsible entity.
By signing and submitting this application the applicant/grantee
certifies that it will comply with the requirements of the Act. The
applicant/grantee further agrees that it will require the language
of this certification be included in any subawards which contain
provisions for the children's services and that all subgrantees
shall certify accordingly.
[FR Doc. 95-15585 Filed 6-23-95; 8:45 am]
BILLING CODE 4184-01-P
