**Annex A**

# DAP Proposal Application Format

**P.L. 480 Title II**

**Country/Cooperating Sponsor**

**FY 05 -- FY xx**

##### 

**Development Assistance Program**

> **Proposal Application Format**
>
> **Resource Request Summary:**

Activity Completion Date: \_\_\_\_\_\_\_\_\_\_\_

Life of Activity Commodity Request (MT): \_\_\_\_\_\_\_\_\_\_\_

> Life of Activity Monetization Budget Request (US\$ Equiv.):
> \_\_\_\_\_\_\_\_\_\_\_

Life of Activity Section 202(e) Budget Request (US\$):
\_\_\_\_\_\_\_\_\_\_\_

> **Date of Submission to USAID/Mission and DCHA/FFP:**
> \_\_\_\_\_\_\_\_\_\_\_

CS HQ Contact Information CS Country Office Contact Information

(including Name/Title, Address, Telephone, (including Name/Title,
Address, Telephone,

*Fax, E-mail)* *Fax, E-mail)*

**Table of Contents**

## Executive Summary 

## Problem Analysis and Proposed Interventions

######## Program Objectives and Design

C.  **Complementarity**

## E. Detailed Implementation Schedule 

**F. Monitoring and Evaluation**

**G. Commodity Market Issues**

**H. Audits**

**I. Activity Resource Requirements**

**J. Waiver Requirements**

**K. Initial Environmental Examination**

**L. Certification Regarding Lobbying**

## M. Certification Regarding Terrorist Financing

## N. Agreements, Contracts, Letters 

> **Appendices**

1.  **Executive Summary Tables**

2.  **Budgets**

    1.  **Comprehensive Budget**

    2.  **Detailed Budget**

    3.  **Negotiated Indirect Cost Rate Agreement**

3.  **Annual Estimate of Requirements -- Pls use electronic format**

4.  **Initial Environmental Examination**

5.  **Certification Regarding Lobbying**

6.  **Certification Regarding Terrorist Financing**

7.  **Agreements**

8.  **Bellmon Analysis**

9.  **Mission Vehicle Procurement Policy**

10. **Country/Intervention Area Map**

A. Executive Summary ([1 page]{.underline},[)]{.underline}

Provide a concise summary of: 1) food security problem to be addressed;
2) strategic objectives and expected results; 3) the proposed program
activities; 4) reason for requesting Title II commodities; 5) resources
required and committed, both in-kind and dollars (or dollar equivalent),
from all sources; and 6) how the results will be measured and monitored.
Briefly present the history of CS activities in the country or region,
including the evolution of the Title II strategy and proposed
interventions. If there is an emergency relief context, discuss the
transition in terms of linkages between relief and development.

The tables associated with the Executive Summary have been moved to the
Annex A, Executive Summary Tables. This annex includes many of the
required tables and instructions for their submissions. The website is:
[*http://www.usaid.gov/our_work/humanitarian_assistance/ffp/dap05_exec_sum.doc*](http://www.usaid.gov/our_work/humanitarian_assistance/ffp/dap05_exec_sum.doc)

B. Problem Analysis and Proposed Interventions ([up to 3 pages if one
objective; up to 6 pages if two or more objectives]{.underline})

The same level of problem analysis is required for all DAP proposals,
whether a follow-on to a previously approved proposal or a completely
new proposal. If a DAP proposal is integrated with Mission activities
and points 1&2 below are covered in the Mission Plan, this plan may
simply be referenced.

1.  Provide a brief description and analysis of the critical food
    security problems facing the population in the country and the
    proposed target area. In this analysis, include or reference
    appropriate national and local level data that is available on the
    degree of food insecurity; major determinants of food insecurity
    (including infectious or water-borne diseases, geo-climatic
    conditions, natural resource constraints, political and
    socio-economic conditions, etc.), and the linkage between these
    factors. Provide data on the geographic distribution of food
    insecurity in the country to justify the choice of geographic
    area(s) targeted. Note: Priority for programs in sub-Saharan Africa
    and South Asia will be reflected in the Congressional Budget
    Justification (CBJ) country allocations determined by FFP. The
    Congressional Budget Justification is the annual budget submitted by
    the Agency to Congress in support of all required expenditures.

2.  Based on this analysis of food insecurity problems, identify the
    priority technical and geographic areas where development assistance
    is needed, and the time line for action. Briefly describe the extent
    to which problems in these priority areas are addressed by
    USAID/DCHA, Global, Mission, World Bank, World Food Program, or
    other development and community organizations. Note which unmet
    development needs remain.

> 3\. Among these unmet needs, describe the capacity and relative
> strengths in your organization for addressing them, technically and
> geographically. Include a statement regarding the institutional
> capacity of your organization, and of local partners (if relevant),
> and the basis upon which this assessment is made.
>
> 4\. Based on the analysis of unmet needs and identification of your
> organization's relative capacity to address them, briefly identify the
> technical and geographic areas that this proposed activity plans to
> address (detailed description should be deferred until section C.2.).
> All DAPs should address problems of food access, availability, and/or
> utilization, with priority placed on activities that increase
> agricultural productivity and/or improve household nutrition. For
> further technical explanation CSs should refer to the USAID Food Aid
> and Food Security Policy Paper at:
> <http://www.usaid.gov/our_work/humanitarian_asssistance/ffp/fspolicy.htm>.
> Reference a country/intervention area map as (and attach as "Appendix
> 10") that clearly defines the area(s) of intervention.
>
> Food security programs with HIV/AIDS-affected populations may be
> supported by Title II resources, where it is determined that HIV/AIDS
> represents a critical constraint to household food security. The
> impact of HIV/AIDS on household food security and how the proposed
> activities would mitigate that impact should be described. CSs are
> encouraged to integrate HIV/AIDS activities and service providers
> funded by other sources (CS, USAID/Mission, etc.) with the Title
> II-funded activities. Where possible, direct co-programming of
> resources (CS, USAID/Mission, etc.) should be undertaken.

C. Program Objectives and Design ([up to 15 pages if one objective, up
to 20 pages if two or more objectives]{.underline})

C.1. Specific Objectives

> The DAP proposal should prioritize program objectives, keeping them
> focused and limited in number and in context with the new FFP strategy
> framework. The objectives and related activities should be categorized
> under one of the following technical sectors:
>
> \(a\) health and nutrition;
>
> \(b\) agriculture, natural resource management and related
> infrastructure;
>
> \(c\) education;
>
> \(d\) micro-enterprise development; and
>
> \(e\) humanitarian assistance.
>
> Any planned capacity-building activity should be subsumed within
> specific food security objectives. Clearly state the objectives and
> intermediate results anticipated over the life of the program. State
> the established timeframe for completion.

C.2. Proposed Activities

> Describe the type, purpose, location, and feasibility of the
> activities, referring to a country/intervention area map to be
> included as **Appendix 10**. Relate activities to the specific
> objectives and technical sectors. Describe how the activities will be
> implemented and by whom. Describe and quantify the target population,
> including what proportion of the area's population will be covered
> under each objective. If the activities are proposed in more than one
> technical sector, describe how and to what extent the interventions
> will be integrated at the community-level. State the amount and type
> of commodity that would be used. Specify how the Title II food and/or
> monetization proceeds will be utilized, and justify the size of the
> ration and the ration mix selected.
>
> Gender issues are important considerations in the design, targeting,
> and management of the program components. DAP proposals should
> describe a gender strategy to ensures equitable participation by both
> men and women in DAP activities.
>
> C.3. Key Assumptions and Risk Management
>
> Discuss the key or critical assumptions of the planned activities and
> any risks that may negatively affect expected results. If relevant,
> include climatic, political, or economic instability or potential for
> other program disruptions. If the proposal includes a monetization
> component, include potential risks and typical problems associated
> with commodity trading (e.g., defaults by buyers, commercial sector
> complaints, fluctuating market prices, and currency devaluation).
> Briefly describe any contingency plans to mitigate the risks and the
> effect of changes in critical assumptions. If the success of the
> planned activities is contingent upon conditions or events outside the
> CS's control (e.g., host government infrastructure, policy or program
> shifts of the host government, or material contributions from other
> organizations), briefly note them. State how they could affect the
> CS's ability to carry out its planned activities and how the CS would
> address this situation.
>
> C.4. Sustainability Strategy
>
> Identify the exit strategy for Title II assistance. Describe a time
> frame for graduation of families from specific components, individual
> communities from the DAP, and the DAP from the geographic area.
> Describe how the activity will promote the financial and/or
> institutional sustainability of intended results. Discuss how
> sustainability will be measured, e.g., cost recovery, financial
> commitment, technical/managerial capacity, community commitment, or
> the capacity of host country counterparts, government, or
> institutions. If applicable, describe the capacity of host country
> counterparts to sustain the results of the activities. If the
> activities are not to be continued, explain why the activity will no
> longer be required.
>
> C.5. Lessons Learned
>
> If the CS had a previous Title II program in the target country, the
> activity design should incorporate lessons learned from previous
> activities and respond to the concerns raised in recent evaluations or
> audits. The design should also include lessons learned from other
> relevant country programs. If the program builds on non-Title II
> investments/activities in the area, outline these activities, their
> impact, and lessons learned for the current DAP proposal design.

D. Complementarity ([up to 1 page]{.underline})

Briefly describe how program interventions support or complement host
government (national, regional, or local), CS, and USAID/Mission
strategic development objectives. Describe how Title II activities
relate to other investments that have occurred in the same geographic
area, ether by the host government, other CSs, USAID, or other donors.
Note any complementarity between the proposed program and other
development activities being undertaken in the country. Indicate where
complementary programs are being carried out. State how Title II
resources are being integrated with other resources. Describe
partnerships and alliances with community and local groups, as well as
with other CSs.

If collaboration with other CSs is anticipated, describe how resources
are to be pooled and describe the relationships and responsibilities
among the group. If a consolidated country program or a consolidated
regional program is being presented, discuss the complementarity between
the programs.

## E. General & Detailed Implementation Plans ([up to 6 pages]{.underline})

Provide a detailed, time-phased implementation plan for the first fiscal
year of the DAP that accurately reflects the interaction of resources,
activities and achievement of performance targets. As such, this plan
should be regarded as a management tool that guides and directs the
annual implementation of the DAP program At a minimum this plan should
include: a list or chart identifying key activities planned; timing of
these activities; person(s) responsible; and the relationship between
the planned activities and the strategic objectives. Activities should
be clearly linked to strategic objectives and specific performance
targets. Indicators should be identified that will be used to track
progress in achieving annual targets and objectives. In addition to the
technical program activities, all training, technical assistance,
evaluation, audit, commodity procurement, and other key support actions
should be included in the activities list of the detailed implementation
plan. Additional narrative is encouraged to further describe the
information provided in the chart to support linkages between activities
and expected achievements. If major assumptions are being made to
support performance targets, these should be noted accordingly.

Provide a general time-phased implementation schedule for each of the
DAP out years. Include a list or chart identifying the following: key
activities planned; timing of these activities; person(s) responsible;
and the relationship between the planned activities and the strategic
objectives, performance indicators, and/or benchmarks established for
each activity. Include all training, technical assistance, evaluation,
audit, commodity procurement, and other key actions.

It is understood that as the implementation of programs evolve over time
there will be changes and refinements to the general implementation
plans for the out-years. For this reason, FFP will request a detailed
implementation plan for each program year as part of the resource
request section of the CSR4. This will ensure that the implementation
plan remains relevant and incorporates lessons learned and feedback from
monitoring and evaluation exercises.

F. Monitoring and Evaluation ([up to 4]{.underline} [pages]{.underline})

2.  

> F.1. Monitoring and Evaluation Plan

Describe the monitoring and evaluation (M&E) plan that will be
implemented to measure the performance indicators and report on the
degree of achievement of results. Joint monitoring and evaluation plans
are encouraged where more than one CS is engaged in similar activities,
and is required where a consolidated proposal is being submitted.

> The DAP proposal should articulate a comprehensive and actionable
> methodology for monitoring and evaluation, including baseline data,
> (or a plan to complete the baseline data collection within the first
> year of the DAP), measurable intermediate results, and procedures to
> collect, analyze, and incorporate results in modifying the activity
> based on lessons learned. A mid-term evaluation should be programmed
> approximately mid-way through the DAP period. The mid-term evaluation
> should provide an assessment of progress in DAP implementation that
> can serve as a management tool to refine program activities and
> improve internal CS management of the program. Emphasis should be
> placed upon the implementation process and effects at the beneficiary
> level. There is no requirement for a population-based survey at
> mid-term, only at the baseline and final impact evaluation. An
> external impact evaluation should be planned for the penultimate year
> of the DAP. The focus of the final evaluation should be the results
> achieved by the program, substantiated with quantitative data from a
> population-based survey. The results of the final evaluation will be a
> primary consideration in the review of follow-on or similar DAP
> proposals.
>
> []{.mark}

A viable Monitoring and Evaluation Plan should include the following:

> a\. For each indicator, clear identification of the type of data to be
> collected, the frequency of data collection, the methodology to be
> used, the population covered, key assumptions anticipated in the
> planned interpretation of data, and the personnel who will collect and
> analyze the data.

b.  Description of the information and data collection systems in place
    or planned that will be used to track progress related to annual
    monitoring indicators; description of how monitoring information
    will be used to adjust activity implementation.

c.  Description of the evaluation component of the activity planned for
    measuring progress related to impact indicators, including personnel
    and funding required; description of the evaluation design,
    including sampling plan and plans for control groups, if any;
    description of the sources of baseline data; and a time line for the
    baseline study (which should be completed within the first year),
    the mid-term evaluation, and an impact evaluation (which should be
    conducted in the fourth year of the program); description of the
    monitoring procedure (technique, frequency) that will be used to
    measure behavioral change where behavioral change is sought.

d.  If required by the Initial Environmental Examination or
    Environmental Assessment, especially for activities in agriculture,
    natural resource management, water and sanitation, and/or physical
    infrastructure development, describe how the environmental impact
    will be monitored. Also, discuss whether the environmental effects
    will be part of the project\'s overall monitoring and evaluation
    system, and if so, whether annual and impact indicators have been
    developed.

> F.2. Results, Performance Indicators and Targets
>
> Performance indicators should measure the extent to which the activity
> results in changes in behavior and well-being at the population level,
> as well as progress in activity implementation. Two types of
> performance indicators should be identified in the DAP proposal:
> impact indicators and annual monitoring indicators. CSs should refer
> to Annex F for a list of resources for additional information on
> indicators.
>
> Where appropriate, indicators and targets should be established to
> capture the impact of mitigation activities that lessen the negative
> impact of a problem, such as a drought, cyclone, or a high prevalence
> of HIV/AIDS, on household food security of a particular target group.
> If possible, CSs should work with USAID/Missions so that CS monitoring
> complements or supplements USAID monitoring and evaluation efforts,
> and vice-versa.
>
> Complete the performance indicator tracking table below with both
> annual monitoring and impact indicators and targets. Quantify the
> current level of each performance indicator, if possible, with primary
> data (baseline) for the population of interest, or with secondary data
> that provide a reasonable estimate of the current situation. Include
> annual targets as appropriate (not applicable as needed) and LOA
> targets for all performance indicators. The magnitude of change in the
> performance indicator, the size of the population affected, and the
> criteria for determining that targets have been achieved, must be
> clear.

Performance Indicator Tracking Table

<table>
<colgroup>
<col style="width: 8%" />
<col style="width: 4%" />
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<col style="width: 4%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Indicator</td>
<td>Base-line</td>
<td><p>Year 1"</p>
<p>Target</p></td>
<td>Year 1" Achieved</td>
<td>Year 1" %Achieved vs Target</td>
<td><p>Year 2"</p>
<p>Target</p></td>
<td>Year 2" Achieved</td>
<td>Year 2" %Achieved vs Target</td>
<td><p>Year 3"</p>
<p>Target</p></td>
<td>Year 3" Achieved</td>
<td>Year 3" %Achieved vs Target</td>
<td><p>Year 4"</p>
<p>Target</p></td>
<td>Year 4" Achieved</td>
<td>Year 4 %Achieved vs Target</td>
<td><p>Year 5"</p>
<p>Target</p></td>
<td>Year 5" Achieved</td>
<td>Year 5" %Achieved vs Target</td>
<td><p>LOA</p>
<p>Target</p></td>
<td><p>LOA</p>
<p>Achieved</p></td>
</tr>
<tr class="even">
<td><p>Component 1</p>
<p>Impact</p>
<p>Indicator 1</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Component 1</p>
<p>Impact</p>
<p>Indicator 2</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Component 1</p>
<p>Monitoring Indicator 1</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Component 1</p>
<p>Monitoring</p>
<p>Indicator 2</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Component 2</p>
<p>Impact</p>
<p>Indicator 1</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Component 2</p>
<p>Impact</p>
<p>Indicator 2</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Component 2 Monitoring Indicator 1</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Component 2</p>
<p>Monitoring</p>
<p>Indicator 2</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
</tr>
</tbody>
</table>

> Note: Annual monitoring indicators should be reported on each year.
> Impact indicators need only be reported on those years determined by
> the CS as appropriate by the CS's monitoring and evaluation plans. If
> the CS adjusts indicators or targets (for example, if found to be
> inappropriate or targets were set too high or low) clear explanation
> should be provided. Note that explicit FFP Approval is required for
> downward revision.

######## G. Audits ([up to ½ page]{.underline})

Provide information regarding the CS's A-133 audit policy/scheduling and
other Title II-related audit activities. Discuss how any outstanding
audit recommendations will be closed and, as required, incorporated into
the activity.

H. Commodity Market Issues ([up to 1 page]{.underline})

######### H.1. Bellmon Analysis

######### 

######### State who carried out the Bellmon analysis and provide a brief statement regarding the summary conclusions, relevant issues or areas of concern, and plans to ensure they are mitigated or resolved. The CS should attach a copy of the analysis as **"Appendix 8."**

H.2. Usual Marketing Requirements

> The Usual Marketing Requirements (UMR) are detailed in the FFP
> Monetization Field Manual. Monetization activities will be undertaken
> only where they will not disrupt commercial markets for agricultural
> commodities. Program levels will be compared with USDA's established
> amount available for US programming under the "usual marketing
> requirements" (UMR) analysis. The UMRs are routinely provided by USDA
> for specific commodities and countries. CSs are encouraged to get the
> UMRs from the USDA in Washington or through their Agriculture Attaches
> or USAID Mission locally. Where this is not possible, CSs may contact
> FFP's Development Programs Division.

I. Activity Resource Requirements ([up to 5 pages]{.underline})

> I.1. Commodities
>
> Programs in a single country should submit a single AER, commodity
> procurement schedule, and life-of-activity commodity requirement
> worksheet, in the electronic format in the Executive Summary Table
> \_\_\_\_. Consolidated regional program proposals should include an
> AER for each country, and reflect individual country data, as well as
> a consolidated total on the remaining charts.
>
> I.1.a. Annual Estimate of Requirements

The CS should submit as "**Appendix 3**" the signed Annual Estimate of
Requirements (AER) form for the first fiscal year of the DAP. Ensure
that package size and commodity type are specifically noted on the AER.
The electronic AER can be found at:
http://www.usaid.gov/our_work/humanitarian_assistance/ffp/fy05_aer.doc.

I.1.b. Commodity Requirement Worksheet for Life of Activity

> The commodity requirement worksheet must include all of the
> commodities for both direct distribution and monetization required for
> program implementation for the performance period of the DAP. A table
> must be completed for each year. This table should now be completed in
> its electronic format (found in the Executive Summary Tables), and
> submitted via e-mail with the complete DAP application. The commodity
> requirement worksheet and instructions for its completion can be found
> at the site below.

See Annex A, Executive Summary Tables, for Commodity Requirement
Worksheets for Life of Activity
[*http://www.usaid.gov/our_work/humanitarian_assistance/ffp/dap05_exec_sum.doc*](http://www.usaid.gov/our_work/humanitarian_assistance/ffp/dap05_exec_sum.doc)

> I.1.c. Commodity Procurement Schedule
>
> The commodity procurement schedule identifies which month the CS would
> like to have commodities to arrive at the U.S. port for the first year
> of the DAP. This table can be found at the website below and must be
> completed as part of the application process.
>
> See Annex A, Executive Summary Tables for Commodity Procurement
> Schedule
> <http://www.usaid.gov/our_work/humanitarian_assistance/ffp/dap05_exec_sum.doc>

## 

> I.1.d. Monetization Plan
>
> Include a monetization plan as outlined in the relevant sections of
> the Title II Monetization Field Manual, referring to the monetization
> criteria and FFP monetization policies. Provide full justification for
> the monetization and describe the proposed mechanics of the
> monetization (type of sale, type of buyer, anticipated commodities,
> whether sale will be conducted with other CSs, etc.). Provide a
> separate monetization sales budget and projected proceeds from sales.
> Discuss sales proceeds management, including "maintenance of value"
> issues, and the vehicle procurement plan, if applicable. Reference the
> FY05 Development Program Polices and Guidelines, Section V. entitled
> CS Preparation and FFP Review of DAP Proposals (d) Monetization.

[Anticipated Monetization Cost Recovery Calculation and
Estimate]{.underline}

> Discuss anticipated cost recovery for the first fiscal year of the
> program. Compare against actual cost recovery achieved in prior year
> (if a follow-on DAP). Justify the monetization on the basis of the
> amount of funding to be made available for programming, as compared to
> the costs incurred in carrying out the monetization. Justify based on
> the generation and use of monetization proceeds and food security
> impacts. Discuss how previously encountered problems will be avoided
> or mitigated and provide details on any localized market factors that
> import market prices and cost recovery.
>
> [Anticipated Monetization Cost Recovery]{.underline}
>
> Complete the worksheet below (add or delete columns, as needed) for
> expected monetization transactions in the first fiscal year of the
> program.

+---------------------------------+-------+-------+-------+---------+
|                                 | >     | >     | >     | Wtd Avg |
|                                 |  Sale |  Sale |  Sale |         |
|                                 | > 1   | > 2   | > 3   |         |
+---------------------------------+-------+-------+-------+---------+
| > 1\. Call Forward Number       |       |       |       | n.a.    |
+---------------------------------+-------+-------+-------+---------+
| > 2\. Expected Sale Date        |       |       |       | n.a.    |
+---------------------------------+-------+-------+-------+---------+
| > 3\. Commodity                 |       |       |       | n.a.    |
+---------------------------------+-------+-------+-------+---------+
| > 4\. Tonnage to be Called      |       |       |       | (total) |
| > Forward (total MT)            |       |       |       |         |
+---------------------------------+-------+-------+-------+---------+
| > 5\. Exchange Rate (estimated) |       |       |       |         |
+---------------------------------+-------+-------+-------+---------+
| > 6\. CS estimated FAS cost     |       |       |       |         |
| > (total \$/MT)                 |       |       |       |         |
+---------------------------------+-------+-------+-------+---------+
| > 7\. Freight estimate (foreign |       |       |       |         |
| > flag)\* (\$/MT)               |       |       |       |         |
+---------------------------------+-------+-------+-------+---------+
| > 8\. Inland freight estimate   |       |       |       |         |
| > (\$/MT)                       |       |       |       |         |
+---------------------------------+-------+-------+-------+---------+
| > 9\. C&F total cost est. using |       |       |       |         |
| > foreign flag (\$/MT)          |       |       |       |         |
+---------------------------------+-------+-------+-------+---------+
| > **10. Anticipated sales price |       |       |       |         |
| > (\$/MT)**                     |       |       |       |         |
+---------------------------------+-------+-------+-------+---------+

*Note: Use exchange rate applicable at time of estimate; FAS=free
alongside ship, C&F=commodity and freight*

> I.1.e. Logistics Plan
>
> Discuss any commodity-related issues, including port facility, storage
> infrastructure, port management capabilities, transport status, and
> commodity pipeline. For landlocked countries, note the points of entry
> (limited to four) for FFP review and approval. For special procurement
> or shipping requests, such as containerization or through bills of
> lading for non-landlocked countries, a detailed justification must be
> attached. If reimbursement for inland transport charges will be
> requested, attach a copy of the
>
> contract covering transport for the first fiscal year of the DAP, and
> an estimate of total U.S. dollars needed for inland transport. If not
> yet available, state when this will be submitted to DCHA/FFP. If the
> subject contract is not in English, a translation of the contract into
> English is required.
>
> I.2. Financial Plan

I.2.a. Budget Narrative

Explain how the financial requirements (in-kind, dollars, foreign/local
currency for the life of the DAP program) will be met. If 202(e),
monetization, ITSH or other funds are expected to be carried over from
the previous fiscal year(s), explain why. Provide a budget narrative(s)
to cover monetization, Section 202(e) and ITSH) funds. Describe any
budget line items or funding sources that are not self-explanatory.
Reference (b) 202(e) funding and (c) Funding for Internal Transport
Storage & Handling (ITSH) under Section V entitled CS Preparation and
FFP Review of DAP Proposals.

I.2.b. Budgets

Attach as "**Appendix 2.1**" the comprehensive budget format summarized
by technical area for each fiscal year and total life-of-activity.

Attach as "**Appendix 2.2**" the detailed monetization, Section 202(e)
and ITSH, for each year of the DAP, based on line item categories (e.g.,
salaries, transportation, capital equipment, etc.). A detailed budget
will be requested for each subsequent year of the DAP with the Resouce
Request of the CSR4.

I.2.c. Indirect Costs

Attach as **"Appendix 2.3"** a copy of the latest approved negotiated
indirect cost rate agreement (NICRA). For a CS that does not have a
provisional or final approved federal rate, submit supporting
documentation in the calculation of the CS's indirect cost (overhead)
rate(s).

> I.3. Human Resources ([up to 1 page]{.underline})

Provide an organizational chart identifying the position titles of CS
staff and the amount of time that will be devoted to each proposed
activity and corresponding responsibilities. List the recipient agencies
(counterpart and/or collaborating organizations, both private and host
government). If not described in the complementarity section of the
original proposal, briefly outline their financial and management roles.
If extensive technical assistance is being planned, explain the scope of
the activity and the individual or organization responsible.

[]{.mark}

> Provide evidence of the organization's technical, financial, and
> managerial capability to design, implement, and monitor the proposed
> activities (including the number and size of programs managed or
> proposed). Describe prior performance implementing food aid programs
> in the proposed country or other countries, if applicable. Describe
> the organization's headquarters, in-country, or regional personnel's
> plans to backstop the DAP proposal. Explicitly address the types of
> capacity building that will take place within the CS or counterparts
> to increase the sustainability of results. Discuss how the use of
> Title II non-emergency resources complements the CS's strategy for the
> particular country and/or region.

[]{.mark}

J. Approval of Non-U.S. Equipment

If procurement of non-U.S. equipment or vehicles is intended, state the
source and/or origin waiver request and provide a justification. For
vehicles, state how many non-U.S. vehicles are planned for purchase,
from which funding source, and justify fully the proposed purchases and
the funding source. Attach as **"Appendix 9."** a copy of the written
USAID/Mission procurement policy.

K. Initial Environmental Examination

Attach as "**Appendix 4."** an Initial Environmental Evaluation (IEE)
cleared by the USAID Mission Director or his/her designee. For
consolidated country proposals, a single IEE that covers all activities
should be submitted. For consolidated regional proposals, an IEE should
be submitted for each country program.

L. Certification Regarding Lobbying

Lobbying certification is required; complete appropriate sections of
**Appendix 5** (see attachment).

M. Certification Regarding Terrorism

In accordance with Executive Order 13224 all applicants for USAID
assistance are required to certify that they do not provide material
support or resources for terrorist acts. Before making the award of a
grant or cooperative agreement to a non-governmental organization the
certification attached in **Appendix 6** must be completed.

N. Agreements, Contracts, Letters

Attach as "**Appendix 7**" a copy of the host country Food for Peace
Agreement, which should make reference to and incorporate or attach
Regulation 11. Indicate whether there are outstanding issues, such as:
the adequacy of the current agreement; exemption from the payment of
taxes on Title II program commodities, material, and equipment; the
continuation of tax exemptions on distribution commodities; how
taxes/fees/tariffs for monetization commodities will be covered; and how
the host country has cooperated with the CS in the implementation of its
programs in accordance with Regulation 11 (in the case of follow-on
DAPs).

Also include memoranda of understanding, inland contracts, letters of
support or agreements with relevant parties, as appropriate. If a
document is lengthy, attach a copy only to the primary ("original")
unbound copy of the proposal to both the Mission and to FFP. Explain
below if a host country agreement is not yet signed, and provide a
timetable for submission. Identify any additional agreements planned but
not yet executed.

### Appendix 5

> **Certification Regarding Lobbying Form**

**[Authority and Statutory Lobbying Restrictions]{.underline}**

*CSs are reminded that statutory lobbying restrictions and reporting
requirements apply to Title II donations to CSs. The requirements of 31
U.S.C. 1352 are that no appropriated funds can be used to influence or
attempt 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 to receive a federal contract, grant, cooperative agreement
or a commitment providing for the United States to insure or guarantee a
loan. CSs are required to submit a Certification Regarding Lobbying form
with each annual submission (OP, DAP Amendment, CSR4s) to certify
compliance with these requirements.*

*Furthermore, 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 a Title II award, a Disclosure Form to Report
Lobbying should be completed and submitted. The Inspector General is
required by law to evaluate annually and report on compliance. USAID
regulations concerning implementation of lobbying restrictions are in 22
CFR 227, which appears in the Automated Directives System (ADS) 200.*

#### **Certification Regarding Lobbying Form**

Submitted in connection with submission of proposal initiating
USAID/BHR/FFP consideration of P.L. 480 Title II grant request including
any or all of the following: commodities; ocean freight; inland freight;
internal transportation; storage and handling; Section 202(e);
Institutional Support.

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, and 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 of Lobbying Activities," 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, United
States Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less that \$10,000 and not
more than \$100,000 for each such failure. By signature hereon, the
applicant/grantee certifies that the information contained herein is
accurate, current, and complete to the best of its knowledge and belief,
and that the applicant/grantee is aware of the penalty prescribed in 18
U.S.C. 1001 for making false statements in applications or proposals.

**Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Typed Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Organization:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Title:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

If applicable, complete this form to disclose lobbying activities
pursuant to 31 U.S.C. 1352

1.  Type of Federal Action:

\_\_\_ a. contract

> b\. grant
>
> c\. cooperative
>
> agreement
>
> d\. loan
>
> e\. loan guarantee
>
> f\. loan insurance

4\. Name and Address of

Reporting Entity:

> \_\_\_\_ Prime
>
> \_\_\_\_ Subawardee
>
> Tier \_\_\_\_ *if known:*
>
> Congressional District, *if known:*

7\. Federal Program

> Name/Description:
>
> CFDA Number, if applicable: \_\_\_\_\_\_\_\_\_\_

10\. a. Name and Address of

Lobbying Entity

(If individual, last name, first name, MI):

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

b\. Individuals Performing Services

(including address if different from No. 10a) (Last name, first, MI):

13\. Type of Payment:

(check all that apply):

a.  Retainer

b.  one-time fee

c.  commission

d.  contingent fee

e.  deferred

f.  other:

> \_\_\_\_\_\_\_\_\_\_

2.  Status of Federal Action:

```{=html}
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```
a.  bid/offer/application

b.  initial award

c.  post-award

```{=html}
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```
5.  If Reporting Entity in No. 4 is Subawardee, Enter Name and address
    of Prime:

> Congressional District, *if known:*

8.  Federal Action Number, *if known:*

11\. Amount of Payment: (check all

that applies):

> \_\_\_\_ actual
>
> \_\_\_\_ planned
>
> \$ \_\_\_\_\_\_\_\_\_\_\_\_\_\_

14. Continuous Sheet(s) SF-LLL-A attached

> \_\_\_\_ yes \_\_\_\_ no

3.  Report Type:

```{=html}
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```
a.  Initial filling

b.  Material change

> For Material Change Only:
>
> Year \_\_\_\_\_ quarter \_\_\_\_\_
>
> Date of last report \_\_\_\_\_\_\_

6.  Federal Department/Agency

```{=html}
<!-- -->
```
9.  Award amount,*if known:*

> \$

12\. Form of Payment (check all

that applies):

> \_\_\_ a. cash
>
> \_\_\_ b. in-kind; specify:
>
> nature\_\_\_\_\_\_\_\_\_\_\_\_
>
> value \_\_\_\_\_\_\_\_\_\_\_\_

15\. Information requested through this form is authorized by title 31
U.S.C. section 1352. This disclosure of lobbying activities is a
material representation of fact upon which reliance was placed by the
tier shown when this transaction was made of xxxxx lobby. This
disclosure is required pursuant to 31 U.S.C. 1352. This information will
be reported to the Congress semi-annually and will be available for
public inspection. Any person who fails to file this required disclosure
shall be subject to a civil penalty of not less than \$10,000 and not
more than \$100,000 for each such failure.

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Print Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone No. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date \_\_\_\_\_\_\_\_\_\_\_

Authorized for Local Reproduction Standard Form - LLL

**DISCLOSURE OF LOBBYING ACTIVITIES** **CONTINUATION SHEET**

0348-0046

Reporting Entity:

Page of \_\_\_\_

\*U.S. G.P.O 1990-260-708:00012

Standard Form - LLL-A

Authorized for Local Reproduction

### Appendix 6

**Certification Regarding Terrorist Financing**

BACKGROUND: Section 2339A of Title 18 of the United States Code
prohibits the provision of material support or resources for terrorist
acts. Section 2339B of Title 18 of the United States Code prohibits the
provision of material support or resources to designated foreign
terrorist organizations, and requires any U.S. financial institution
that becomes aware that it has possession of, or control over, any funds
in which a designated foreign terrorist organization, or its agent, has
an interest, to retain possession of, or maintain control over, such
funds and report to the Secretary of the Treasury the existence of such
funds.

Section 1189 of Title 8 of the United States Code (section 219 of the
Immigration and Nationality Act, as amended by P.L. 107-56) authorizes
the Secretary of State to designate an organization as a terrorist
organization if the Secretary finds that the organization (1) is a
foreign organization, (2) engages in terrorist activity (as defined in
section 212(a)(3)(B) of the Immigration and Nationality Act) or
terrorism (as defined in section 140(d)(2) of the Foreign Relations
Authorization Act, Fiscal Years 1988 and 1989 (22 U.S.C. § 2656f(d)(2)),
or retains the capability and intent to engage in terrorist activity or
terrorism, and (3) the terrorist activity or terrorism of the
organization threatens the security of U.S. nationals or the national
defense, foreign relations, or economic interest of the United States.

Executive Order 12947, as amended by Executive Order 13099, designated
16 individuals and entities that threaten to disrupt the Middle East
peace process, and authorized the Secretary of State, in coordination
with the Secretary of the Treasury and the Attorney General, to
designate foreign individuals or entities that are found to have
committed, or to pose a significant risk of committing, acts of violence
that have the purpose or effect of disrupting the Middle East peace
process, or to have provided support for or services in support of such
acts of violence. The

Secretary of the Treasury is authorized to designate, in coordination
with the Secretary of State and the Attorney General, individuals or
entities that are determined to be owned or controlled by, or are acting
for or on behalf of, designated individuals or entities. All property
and interests in property in the U.S. or in the possession or control of
U.S. persons of designated individuals and entities are blocked, and any
transaction or dealing in blocked property or interests in the U.S. or
by U.S. persons is prohibited.

Executive Order 13224 designated 27 individuals and entities that have
committed, threaten to commit or support global acts of terrorism, and
authorized the Secretary of State, in consultation with the Secretary of
the Treasury and Attorney General, to designate additional foreign
individuals and entities determined to have committed, or to pose a
significant risk of committing, acts of terrorism that threaten the
security of U.S. nationals or the national security, foreign policy, or
economy of the United States, and authorized the Secretary of the
Treasury, in consultation with the Secretary of State and the Attorney
General, to designate additional individuals or entities determined to
provide support for or financial or other services to or in support of
such acts of terrorism or persons designated in or pursuant to the
Order, or individuals or entities that are owned or controlled by, act
for or on behalf of, or are otherwise associated with, certain
individuals or entities that have been designated in or under the Order.
All property and interests in property of designated individuals or
entities in the U.S. or in the possession or control of U.S. persons are
blocked, and any transaction or dealing in blocked property or interests
in the U.S. or by U.S. persons is prohibited.

OMB has approved the Agency\'s information collection request under the
Paperwork Reduction

Act allowing USAID to require applicants for assistance to give a
certification that they do not

support terrorism. The approval is in effect from the date of this
notice, and expires upon the earlier of incorporation of this AAPD into
ADS 303 or December 31, 2005.

GUIDANCE: Before making the award of a grant or cooperative agreement to
a non-governmental organization, the Agreement Officer must obtain a
certification from both U.S. and non-U.S. organizations, substantially
as follows:

**Certification Regarding Terrorist Financing Form**

"As a condition of entering into the referenced agreement, \[name of
organization\] hereby certifies that it has not provided and will not
provide material support or resources to any individual or entity that
it knows, or has reason to know, is an individual or entity that
advocates, plans, sponsors, engages in, or has engaged in terrorist
activity, including but not limited to the individuals and entities
listed in the Annex to Executive Order 13224 and other such individuals
and entities that may be later designated by the United States under any
of the following authorities: § 219 of the Immigration and Nationality
Act, as amended (8U.S.C. § 1189), the International Emergency Economic
Powers Act (50 U.S.C. § 1701 et seq.), the National Emergencies Act (50
U.S.C. § 1601 et seq.), or § 212(a)(3)(B) of the Immigration and
Nationality Act, as amended by the USA Patriot Act of 2001, Pub. L.
107-56 (October 26, 2001)(8 U.S.C. §1182). \[Name of organization\]
further certifies that it will not provide material support or resources
to any individual or entity that it knows, or has reason to know, is
acting as an agent for any individual or entity that advocates, plans,
sponsors, engages in, or has engaged in, terrorist activity, or that has
been so designated, or will immediately cease such support if an entity
is so designated after the date of the

referenced agreement.

For purposes of this certification, \"material support and resources\"
includes currency or other financial securities, financial services,
lodging, training, safe houses, false documentation or identification,
communications equipment, facilities, weapons, lethal substances,
explosives, personnel, transportation, and other physical assets, except
medicine or religious materials. For purposes of this certification,
\"engage in terrorist activity\" shall have the same meaning as in
section 212(a)(3)(B)(iv) of the Immigration and Nationality Act, as
amended (8 U.S.C. § 1182(a)(3)(B)(iv)). For purposes of this
certification, "entity" means a partnership, association, corporation,
or other organization, group, or subgroup.

This certification is an express term and condition of the agreement and
any violation of it shall be grounds for unilateral termination of the
agreement by USAID prior to the end of its term."

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Print Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone No. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date \_\_\_\_\_\_\_\_\_\_\_