[Federal Register Volume 60, Number 172 (Wednesday, September 6, 1995)]
[Notices]
[Pages 46283-46287]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-22054]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration on Aging
[Program Announcement 13655.911]
Grants to Indian Tribal Organizations for Supportive and
Nutritional Services for Older Indians
AGENCY: Administration on Aging (AoA), OS, HHS.
ACTION: Announcement of availability of funds and opportunity to apply
under the Older Americans Act, Title VI, Grants for Native Americans,
Part A-Indian Program.
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SUMMARY: The Administration on Aging will accept applications for
funding in Fiscal Year 1996 under the Older Americans Act, title VI,
Grants for Native Americans, part A-Indian Program, from all current
title VI, part A grantees, current grantees who wish to leave a
consortium and apply as a new grantee, and eligible federally
recognized Indian tribal organizations that are not now participating
in title VI. Successful applications from new grantees will be funded
if funds permit.
DATES: December 5, 1995.
ADDRESSES: See Appendix A.
FOR FURTHER INFORMATION CONTACT:
M. Yvonne Jackson, Ph.D., Office for American Indian, Alaskan Native,
and Native Hawaiian Programs, Administration on Aging, Department of
Health and Human Services, Wilbur J. Cohen Federal Building, Room 4257,
330 Independence Avenue, SW, Washington, DC 20201, telephone (202) 619-
2713.
SUPPLEMENTARY INFORMATION:
1. Background and Program Purpose
The Administration on Aging (AoA) is responsible for administering
title VI, part A of the Older Americans Act, which provides for grants
to Indian tribal organizations representing federally recognized Tribes
for the provision of nutritional and supportive services to Indian
elders.
The 1978 Amendments to the Older Americans Act created title VI,
Grants for Indian Tribal Organizations. The purpose of this title is to
promote the delivery of supportive and nutritional services for Indian
elders that are comparable to services provided under title III of the
Older American Act. (Title III of the Older Americans Act, entitled
``Grants for State and Community Programs on Aging'' is the nationwide
program of supportive and nutritional services which serves persons
over age 60 of all ethnic groups.)
In the Older Americans Act Amendments of 1987, the name of title VI
was changed to Grants for Native Americans, and part B--Native Hawaiian
Programs--was added.
Nutritional services and information and assistance services are
required by the Act. Nutritional services include congregate meals and
home-delivered meals. Supportive services include information and
assistance, transportation, chore services, and other supportive
services which contribute to the welfare of older Native Americans.
2. Eligibility of an Indian Tribal Organization or Indian Tribe To
Receive a Grant
To be eligible to receive a grant, a tribal organization or Indian
tribe must meet the application requirements contained in sections
612(a) and 612(b) of the Act, which are: ``(1) the tribal organization
represents at least 50 individuals who are 60 years of age or older;
and (2) the tribal organization demonstrates the ability to deliver
supportive services, including nutritional services.'' For purposes of
title VI, part A, the terms ``Indian tribe'' and ``tribal
organization'' have the same meaning as in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450b).
This announcement concerns all federally recognized Indian tribal
organizations, those currently participating in title VI, part A
individually or as members of a consortium and those that are not
currently participating in title VI, part A.
3. Available Funds
Distribution of funds among tribal organizations is subject to the
availability of appropriations to carry out title VI, part A. As stated
in section 614A(b) of the Act the amount of the grant made under this
part to a tribal organization for fiscal year 1992 and for each
subsequent fiscal year shall be not less than the amount of the grant
made under this part to the tribal organization for fiscal year 1991 as
stated under section 614A(a) of the Act. If the funds appropriated to
carry out this part in a fiscal year subsequent to fiscal year 1991
exceed the funds appropriated to carry out this part in fiscal year
1991, then the amount of the grant (if any) made under this part to a
tribal organization for the subsequent fiscal year shall be: (1)
Increased by such amount as the Assistant Secretary considers to be
appropriate, in addition to the amount of any increase required by
subsection (a), so that the grant equals or more closely approaches the
amount of the grant made under this part to the tribal organization for
fiscal year 1980; or (2) an amount the Assistant Secretary considers to
be sufficient if the tribal organization did not receive a grant under
this part for either fiscal year 1980 or fiscal year 1991.
Applications from current grantees who are a part of a consortium
and wish to leave the consortium will be treated as new grant
applications. Successful new grant applications for both current
grantees who are leaving a consortium and tribal organizations who are
not current grantees will be funded pending availability of additional
funds.
Information on typical grant levels in Fiscal Year 1994 is given
below as a guide to POSSIBLE funding levels for Tribes representing the
following documented numbers of Indian elders over age 60:
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Amounts
Population range (No. of older Indians age 60 years and over, of awards
represented by the tribal organization) in FY
1994
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50 to 100.................................................... $49,000
101 to 200................................................... 56,000
201 to 300................................................... 64,500
301 to 400................................................... 73,000
401 to 500................................................... 81,600
501 to 1500.................................................. 95,000
1501+........................................................ 125,000
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4. Application Process
Applicants should submit applications, describing their proposed
plans for nutritional and supportive services for older Indians for
project period April 1, 1996-March 31,1999, as described in section 5
below, ``Content of the Application.''
A three year project period was chosen in order to reduce the
paperwork burden on the grantees. It is the intent of this agency to
conduct on site monitoring at least once during the three year project
period.
The Program Performance and Financial Status reports, due on a
semi-annual basis, will be reviewed for compliance with the program
regulations. Failure to submit the required reports during the project
period may result in loss of future funds and possibly termination of
the grant within the project period.
Thirty days prior to the end of each budget period within the three
year project period grantees shall notify AoA
[[Page 46284]]
as to their desire to continue as a grantee. Failure to submit this
documentation within the required timeframe may result in loss of grant
funding. At the beginning of each budget period within the three year
project period grantees will be notified of the funding level for the
subsequent year.
One original application, signed by the principal official of the
Tribe, and two copies of the complete application including all
attachments must be submitted to the Administration on Aging, Grants
Management Division, Margaret Tolson, Director, 330 Independence
Avenue, SW., Washington, DC 20201. Incomplete applications will not be
considered for funding.
5. Content of the Application
The application must meet the criteria in sections 614(a) and (b)
of the Act, and title 45 of the Code of Federal Regulations,
Sec. 1326.19. The application may be presented in any format selected
by the tribal organization. Contact the AoA Regional Office in your
geographic area if you have questions concerning the content of the
application. The application must include the following information:
A. Objectives and Need for Assistance
This section must include objectives, expressed in measurable
terms, which are related to the current supportive and nutrition
service needs of the elders to be represented by the Tribal
Organization. This section must also include a discussion of how the
needs were evaluated.
B. Results or Benefits Expected
The application should describe the results or benefits expected
from each service proposed.
C. Approach
(1) Description and Method of Delivery of Each Service
(a) Nutrition. Nutrition services are required. There should be a
description of the methods, facilities, and staff to be used in
preparing, serving, and delivering meals, and the estimated number of
persons to be served. The nutrition services provided, either directly
or by way of a grant or contract, must be substantially in compliance
with the provisions of part C, title III, which include:
1. Provide at least one hot or other appropriate meal a day, 5 or
more days a week in a congregate setting, and any additional meals
which the recipient of a grant may elect to provide. A ``meal'', as
used in section 307(a)(13), 308(b)(7), 311(a)(4), 331(1), 336,
338(a)(1), and 339, 339A of the Act and Sec. 1321.17, Sec. 1321.59 and
Sec. 1321.64, is a planned event in a day at which a variety of
prepared foods are provided to an individual. These foods shall comply
with the U.S. Dietary Guidelines for Americans published by the
Secretary of the Department of Health and the Secretary of the
Department of Agriculture and provide the nutrients specified in the
current, daily Recommend Dietary Allowances, as established by the Food
and Nutrition Board of the National Research Council of the National
Academy of Sciences as specified in Section 339(2) unless the meal is a
special meal provided to meet the health, religious, or ethnic
considerations of eligible individuals. Snacks, partial meals, and
second helpings are not considered meals.
2. Provide at least one home delivered hot, cold, frozen, dried,
canned, or supplemental food (with a satisfactory storage life) meal
per day, 5 or more days a week, and any additional meals which the
recipient of a grant may elect to provide. The above definition of a
meal also applies here. Thus, neither individual grocery items nor food
vouchers may not be used in lieu of home delivered meals.
If no title VI, part A funds are to be used for nutrition services,
the application must state how such services are provided in other
ways, and how they are financed.
(b) Information and Assistance. Information and assistance services
are required. They must be available for older Indians living in the
title VI part A service area and there should be a description of what
information and assistance services will be provided and how they will
be provided. The estimated number of individuals to be served should be
stated. If no title VI, part A funds are to be used for information and
assistance services, the application must state how such services are
provided in other ways, and how they are financed.
(C) Other Supportive Services. The application must describe any
other supportive services to be provided wholly or partly by title VI,
part A funds. The description should include what supportive services
will be provided and how they will be provided. The approximate number
of persons to be served by each service should be stated.
Legal assistance and ombudsman services may be provided, but are
not required. However, if provided, they should be reported as
``Supportive Services.''
If a tribal organization elects to provide legal services, it must
substantially comply with the requirements in title 45 of the Code of
Federal Regulations Sec. 1321.71, and all legal assistance providers
must comply fully with the requirements in Sec. 1321.71(d) through
Sec. 1321.71(k).
Transportation of persons to nutrition sites or other places is to
be considered as a ``Supportive Service.''
(D) Coordination with title III. The application should provide a
description of how title VI and title III resources are to be
coordinated within the title VI service area, including information and
assistance service.
(2) Evaluation Criteria
The application must discuss the criteria to be used to evaluate
the results and successes of the program, based on the objective
indicated in Item A above. It will also 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 in Item B above
are being achieved.
D. Geographic Location
The application must include both a narrative description of the
title VI, part A service area, and a map with the service area
identified. The area to be served by title VI, part A must have clear
geographic boundaries. If the geographic area overlaps with another
current title VI, part A grantee or new applicant then coordination of
services without duplication must be developed between the two
applicants and clearly outlined in the application. This agreement must
be signed by the principal official of both tribal organizations. A
``Consortium Agreement'' is included in the attachments of this Federal
Register announcement. There is no prohibition, however, on its
overlapping with areas served by title III.
E. Additional Information
(1) Older Indians in the Title VI, Part A Service Area
The law requires that a tribal organization must represent at least
50 persons aged 60 years or over in order to be eligible for title VI
funding. Therefore, the number of persons aged 60 or over living in the
proposed title VI service area must be stated in the application. The
tribal organization may use Bureau of Statistics population figures, or
may develop its own population statistics, but they must be certified
from the Bureau of Indian Affairs in order to establish eligibility.
The amount of the grant is based on this
[[Page 46285]]
number of Indians or Alaskan Natives aged 60 years or over in the
proposed service area. Thus, the application should include only the
number of Indians and Alaskan Natives aged 60 years or over in the
proposed service area and not the total population census of all tribal
members, age 60 and above, if not all the tribal members live in the
proposed service area. If there is overlap between two or more title
VI, part A applicants, as stated under ``Geographic Location'', the
eligible elders can only be counted once and included in one
application. The applicants are responsible for determining how the
eligible elders will be counted. The same elder may not be counted by
both applicants. This must be stated clearly in the application and
signed by the principal official of the tribal organization.
As a separate matter, the regulations allow a Tribe to define,
based on its own criteria, who the Tribe will consider to be an ``older
Indian'' for purposes of eligibility to receive title VI services. If a
Tribe selects a different definition of ``older Indian'' for service
delivery, the application must state the age selected, and the number
of Indians under age 60 eligible to be served. If more than one Tribe
is included in the application, this information must be stated
separately for each Tribe. All Tribes in a consortium must use the same
age for ``older Indian.''
(2) Resolution
The tribal organization representing a federally recognized Tribe
must submit an original copy of the Tribal council resolution
authorizing participation in title VI, part A. If the tribal
organization represents a consortium of more than one Tribe, a
resolution is required from each participating Tribe, specifically
authorizing representation by the tribal organization for the purpose
of title VI, part A of the Older Americans Act.
(3) Program Assurances
Title VI, part A Program Assurances must be included in the
application. The title VI, part A Program Assurances are those
provisions identified in section 614(a) of the Older Americans Act, and
in title 45 of the Code of Federal Regulations Sec. 1326.19(d), issued
August 31, 1988 (see Appendix B). The tribal organization must state
that it agrees to abide by all the provisions for the entire project
period being applied for April 1, 1993-March 31, 1996.
Copies of the title III and title VI current law and regulations,
and of part 92, may be obtained from the Regional Program Director for
the Administration on Aging. (See appendix A)
(4) Certification Forms
Certifications are required of the applicant regarding (a)
lobbying; (b) debarment, suspension, and other responsibility matters;
and (c) 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) Identifying Information
Applications must identify both the principal official of the
tribal organization, and the proposed title VI program director: Name,
Title, Address including Zip Code, Telephone Number, and, if available,
the FAX Number. The tribal organization's EIN (Employer Identification
Number) must also be included.
If the applicant tribal organization is a consortium, the applicant
must list the federally recognized tribes which are included. A copy of
each tribal resolution must be enclosed.
6. Closing Date for Application
To be eligible for consideration, applications must be received or
postmarked on or before December 5, 1995. (Applicants are cautioned to
request a legibly dated U.S. Postal service postmark, or to obtain a
legibly dated receipt from a commercial carrier or the U.S. Postal
Service. Private metered postmarks are not acceptable as proof of
timely mailing.)
7. Action on Applications
Awards will be made by the Assistant Secretary on Aging Funding
decisions will be announced as soon as possible.
Catalog of Federal Domestic Assistance Program #93.655 Grants to
Indian Tribes and Native Hawaiians. This Program Announcement is not
subject to E.O. 12372.
Dated: July 7, 1995.
Fernando M. Torres-Gil,
Assistant Secretary for Aging.
Appendix A
Regional Offices
Region 1 (CT, MA, ME, NH, RI, VT)
Thomas Hooker, Regional Administrator, John F. Kennedy Building,
Room 2075, Boston, Massachusetts 02203, (617)565-1158, FAX (617)565-
4511
Region II (NY, NJ, PR, VI)
Judith Rackmill, Regional Administrator, 26 Federal Plaza, Room 38-
102, New York, New York 10278, (212)264-2976, FAX (212)264-0114
Region III (DC, MD, VA, DE, PA, WV)
Paul E. Ertel, Jr., Regional Administrator, 3535 Market Street, P.O.
Box 13716-Stop 23, Philadelphia, Pennsylvania 19101, (215)596-6891,
FAX (215)596-0614
Region IV (AL, FL, MS, SC, TN, NC, KY, GA)
Frank Nicholson, Regional Administrator, 101 Marietta Tower, Suite
1702, Atlanta, Georgia 30323, (404)331-5900, FAX (404)331-2017
Region V (IL, IN, MI, MN, OH, WI)
Marion Mengert, Acting Regional Administrator, 105 West Adams
Street, 10th Floor, Chicago, Illinois 60603, (312)353-3141, FAX
(312)886-8533
Region VI (AR, LA, OK, NM, TX)
John Diaz, Regional Administrator, 1200 Main Tower Building, Room
1000, Dallas, Texas 75202, (214)767-2971, FAX (214)767-2951
Region VII (IA, KS, MO, NE)
Larry Brewster, Regional Administrator, 1150 Grand Avenue, suite
600, Kansas City, Missouri 64106, (816)374-6015, FAX (816)374-6024
Region VIII (CO, MT, UT, WY, ND, SD)
Percy Devine, Regional Administrator, 1961 Stout Street, Room 308,
Federal Office Building, Denver, Colorado 80294, (303)844-2951, FAX
(303)844-2943
Region IX (CA, NV, AZ, HI, GU, TTPI, CNMI, AS)
Frank Cardenas, Regional Administrator, 50 United Nations Plaza,
Room 480, San Francisco, California 94102, (415)556-6003, FAX
(415)556-7393
Region X (AK, ID, OR, WA)
Chisato Kawabori, Regional Administrator, Blanchard Plaza, RX-33;
Room 1202, 2201 Sixth Avenue, Seattle, Washington 98121, (206)615-
2298, FAX (206)615-2305
Appendix B
Older Americans Act--Section 614(a)--No grant may be made under
this part unless the eligible tribal organization submits an
application to the Assistant Secretary which meets such criteria as
the Assistant Secretary may by regulation prescribe. Each such
application shall--
(1) Provide that the eligible tribal organization will evaluate
the need for supportive and nutrition services among older Indians
to be represented by the tribal organizations;
(2) Provide for the use of such methods of administration as are
necessary for the proper and efficient administration of the program
to be assisted;
(3) Provide that the tribal organization will make such reports
in such form and containing such information, as the Assistant
Secretary may reasonably require, and comply with such requirements
as the Assistant Secretary may impose to assure the correctness of
such reports;
(4) Provide for periodic evaluation of activities and projects
carried out under the application;
(5) Establish objectives consistent with the purposes of this
part toward which activities under the application will be directed,
identify obstacles to the attainment of such objectives, and
indicate the manner in which the tribal organization proposes to
overcome such obstacles;
(6) Provide for establishing and maintaining information and
assistance
[[Page 46286]]
services to assure that older Indians to be served by the assistance
made available under this part will have reasonably convenient
access to such services;
(7) Provide a preference for Indians aged 60 and older for full
or part-time staff positions whenever feasible;
(8) Provide assistance that either directly or by way of grant
or contact with appropriate entities nutrition services will be
delivered to older Indians represented by the tribal organization
substantially in compliance with the provisions of part C of title
III, except that in any case in which the need for nutritional
services for older Indians represented by the tribal organization is
already met from other sources, the tribal organization may use the
funds otherwise required to be expended under this clause for
supportive services;
(9) Contain assurance that the provision of sections
307(a)(14)(A) (i) and (iii), 307(a)(14)(B), and 307(a)(14)(C) will
be complied with whenever the application contains provisions for
the acquisition, alteration, or renovation of facilities to serve as
multipurpose senior centers;
(10) Provide that any legal or ombudsman services made available
to older Indians represented by the tribal organization will be
substantially in compliance with the provisions of title III
relating to the furnishing of similar services; and
(11) Provide satisfactory assurance that fiscal control and fund
accounting procedures will be adopted as may be necessary to assure
proper disbursement of, and accounting for, Federal funds paid under
this part to the tribal organization, including any funds paid by
the tribal organization to a recipient of a grant or contract.
45 CFR 1326.19 * * * The application shall provide that:
(d) Assurances as prescribed by the Assistant Secretary that:
(1) A tribal organization represents at least 50 individuals who
have attained 60 years of age or older;
(2) A tribal organization shall comply with all applicable State
and local license and safety requirements for the provision of those
services;
(3) If a substantial number of the older Indians residing in the
service area are of limited English-speaking ability, the tribal
organization shall utilize the services of workers who are fluent in
the language spoken by a predominant number of older Indians;
(4) Procedures to ensure that all services under this part are
provided without use of any means tests;
(5) A tribal organization shall comply with all requirements set
forth in Sec. 1326.7 through Sec. 1326.17; and
(6) The services provided under this part will be coordinated,
where applicable, with services provided under title III of the Act.
Consortium Agreement
It is agreed by all participating Principal Officials that
coordination of services, without duplication within a specified
geographic area, has been developed between the two or more Tribal
Organizations applying for this grant. The application and map of
service area reflect this understanding.
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Signature and Date
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Tribal Organization
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Tribal Organization
(Additional pages for signatures may be added if needed.)
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 take 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 government wide
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 studies.)
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
[[Page 46287]]
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 or 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,
of 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).
The grantee may insert in the space provided below the site(s)
for the performance of work done in connection with the specific
grant (Use attachments, if needed):
Place of Performance (Street address, City, County, State, ZIP Code)---
Check ______ if there are workplaces on file that are not identified
here.
Sections 76.630 (c) and (d)(2) and 76.635 (a)(1) and (b) provide
that a Federal agency may designate a central receipt point for
STATE-WIDE AND STATE AGENCY-WIDE certifications, and for
notification of criminal drug convictions. For the Department of
Health and Human Services, the, central receipt point is: Division
of Grants Management and Oversight, Office of Management and
Acquisition, Department of Health and Human Services, Room 517-D,
200 Independence Avenue, SW., Washington, DC 20201.
Signature--------------------------------------------------------------
Date-------------------------------------------------------------------
Title------------------------------------------------------------------
Organization-----------------------------------------------------------
DGMO Form #2 Revised May 1990
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 its
principals involved:
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from covered
transactions by any Federal department of agency;
(b) have not within a 3-year period preceding this proposal been
convicted of or had a civil judgement 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 government 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 for
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 Transactions'', provided below,
without modification in all lower tier covered transactions and in
all solicitations for lower tier covered actions.
Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusions--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 participants 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 Exclusions--Lower Tier Covered Transactions'' without
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
Signature--------------------------------------------------------------
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Organization-----------------------------------------------------------
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 recipients
shall certify and disclose accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
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Organization
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Authorized Signature Title Date
Note: If Disclosure Forms are required, please contact: Mr.
William Sexton, Deputy Director, Grants and Contracts Management
Division, room 341F, HHH Building, 200 Independence Avenue, SW,
Washington, D.C. 20201-0001.
[FR Doc. 95-22054 Filed 9-5-95; 8:45 am]
BILLING CODE 4130-01-M
