**OSM 51**

OMB Approval No. 1029-0072

Exp. Date 1/31/2006

OPTIONAL FORM; CAN USE PLAIN PAPER

U.S. DEPARTMENT OF THE INTERIOR

Office of Surface Mining

Washington, DC 20240

> Performance Report [\_X\_]{.underline} Program Narrative Statement

+-----------------+-----------------+-----------------+-----------------+
| 1\. Type of     |                 | \_\_\_\_ State  |                 |
| Program (Check  |                 | and Federal     |                 |
| Appropriate     |                 | Program         |                 |
| Box)            |                 |                 |                 |
|                 |                 |                 |                 |
| > \_\_[X]{      |                 |                 |                 |
| .underline}\_\_ |                 |                 |                 |
| > Abandoned     |                 |                 |                 |
| > Mine Land     |                 |                 |                 |
| > Program       |                 |                 |                 |
+-----------------+-----------------+-----------------+-----------------+
| 2\. Recipient   | Type of Report  | Reporting       | CA Number       |
|                 |                 | Period          |                 |
+-----------------+-----------------+-----------------+-----------------+
| 3\. Project     |                 |                 |                 |
| Title/Program   |                 |                 |                 |
+-----------------+-----------------+-----------------+-----------------+
| 4\. Performing  |                 |                 |                 |
| Organization    |                 |                 |                 |
+-----------------+-----------------+-----------------+-----------------+
| 5\. Program     |                 |                 |                 |
| Narrative       |                 |                 |                 |
+-----------------+-----------------+-----------------+-----------------+

OSM-51(12/80)

OPTIONAL FORM

Paperwork Reduction Act Statement

The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to
inform you that: Federal Agencies may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless
it displays a currently valid OMB control number. This information is
being collected in order to better you in the future and as part of
OSM's performance of its responsibilities under the Government
Performance and Results Act. The obligation to respond is required to
obtain a benefit.

**INSTRUCTIONS FOR COMPLETING THE PROGRAM NARRATIVE**

*The use of the OSM 51 form is optional.* *The narrative, with the
following information, is required.*

1\. Check the appropriate box to indicate the name of the program for
which the OSM 51 is being submitted.

2\. Enter the name of the grant applicant.

3\. Enter the exact title of the grant; for example, FY 2003 Alabama AML
Grant.

4\. Enter the name of the performing organization if different from the
grant recipient.

5\. Enter the program narrative statement. Note that project specific
information is addressed through the \"authorization to proceed \"
process, and is, therefore, not required here.

> A. As detailed in OMB Circular A-102 (Revised), the Program Narrative
> Statement should include the following information:
>
> **Objectives and Need for Assistance**. Using the approved AML State
> Program as the guideline, describe any relevant abandoned mine land
> problems (physical, economic, social, financial, or institutional)
> requiring a solution. Indicate the need for the assistance and state
> the principal and subordinate objectives of the grant. Relevant data
> based on planning studies should be included or footnoted.
>
> **Results and Benefits Expected**. Identify results and benefits to be
> derived from the reclamation program. For example, describe how the
> reclamation program will improve the environment and protect the
> health, safety, and welfare of the public.
>
> **Approach**. Outline a plan of action pertaining to the scope of the
> grant and describe how the proposed work will be accomplished. Cite
> factors (such as weather, eligibility issues, etc.) which might
> accelerate or decelerate the work and your reasons for taking this
> approach as opposed to others. Describe any unusual features of this
> grant, such as design/ technological innovations, and reductions in
> cost or time. Identify the kinds of data to be collected and
> maintained. Discuss the criteria and methodology to be used to
> evaluate the results and success of the reclamation program.
>
> **Geographic Location**. No information required.
>
> B. OSM has minimized as much as possible its requirements for
> additional information, while still meeting its responsibility to
> ensure that there is no fraud, waste, or abuse in its Federal programs
> and complying with other Federal requirements (such as OMB Circular
> A-87, which requires prior Federal approval for the purchase of
> certain items). Therefore, provide the following general information
> for the below listed items that comprise (1) Administrative Costs and
> (2) Project Support Costs, regardless of budget/cost category.
> [Note:]{.underline} This information will generally be sufficient to
> address the above requirements. However, there may be instances (i.e.,
> significant changes to the grant program) which may require the
> submission of additional information to the RCC/FO.

**Instructions for Completing the Program Narrative (Continued)**

> **Personnel**. Provide an estimate of the number and type of full-time
> equivalent positions supported by this grant.
>
> **Fringe Benefits**. Provide the basis and estimated total amount of
> fringe benefits.
>
> **Travel**. Provide the basis for the computation of travel expenses
> (e.g., 5 trips, for \"y\" purpose, at an average cost of \$100 per
> trip; 3 people to attend 3-day meeting for \"y\" purpose at \$200
> each - \$100 transportation and \$100 subsistence).
>
> **Equipment**. Provide the estimated dollar amount of total equipment
> to be purchased, leased or rented. Itemize equipment major, e.g.,
> vehicles, computer-related.
>
> **Supplies**. Enter estimated dollar amount of supplies. Include an
> itemization of computer-related hardware.
>
> **Contractual**. Provide a list by purpose and estimated dollar amount
> of contracts.
>
> **Other**. Include other items not reimbursed as an indirect cost
> (e.g., rent, reproduction, telephone, janitorial and security
> services). Provide a list by major type with the basis for
> computation.
>
> C. Several AML programs require that specific information be included
> in the program narrative statement. See the following chapters for
> guidance on the specific **program** requirements:
>
> 4-10 - Subsidence Insurance Program
>
> 4-20 - Set-Aside Program
>
> 4-40 - Acid Mine Drainage Fund
>
> D. To ensure consistent classification of costs as either \"project\",
> \"administrative" or \"indirect\" for purposes of the Abandoned Mine
> Land (AML) Grant Program, grantees shall provide the following
> information as part of the program narrative (OSM 51) for each new AML
> grant:
>
> Project Costs: \$
>
> Administrative Costs: \$
>
> Indirect Costs: \$
>
> The total of the three items must equal the grant request.

**Instructions for Completing the Program Narrative (Continued)**

> **Project Costs** include the following construction and
> construction-related activities:
>
> 1\. Project Development - Scope of work preparation, field
> investigation and sampling, eligibility determinations, NEPA
> documentation, clearances, and preparation of problem area information
> for funding and project completion.
>
> 2\. Project Design - Aerial photography, mapping, detailed
> construction plans, specifications, bidding documents, permits.
>
> 3\. Realty Work - Ownership determinations, rights of entry, lien
> evaluations and filing, acquisition.
>
> 4\. Construction contract bidding and management.
>
> 5\. Construction costs, including exploratory drilling.
>
> 6\. Construction inspection - site inspections, job conferences,
> surveys, aerial inspections.
>
> 7\. Post-construction costs - project monitoring, abatement work.
>
> **Administrative Costs** include the following
> non-construction-related activities:
>
> 1\. Inventory system management, including reviewing, revising and
> identifying problem areas in the AML inventory.
>
> 2\. Program policy development - State/Tribe Reclamation Plan
> management, law/regulation analysis, program policy issues,
> association business.
>
> 3\. Program support - Personnel management, fiscal and legal support,
> grant administration, training, seminars and public information costs.
>
> 4\. Nonconstruction project costs - Subsidence insurance, future
> set-aside program and acid-mine drainage fund.
>
> **Indirect Costs** - Total indirect funds included in the grant.
> Indirect cost is calculated by multiplying the appropriate indirect
> cost rate by the appropriate direct cost base of the grant, as defined
> by the grantee\'s Negotiation Agreement with the Federal cognizant
> agency.

**EXHIBIT 4**

**CERTIFICATIONS**

**Certification -- Debarment, Suspension, and Other Responsibility
Matters**

This certification is required by the regulations implementing Executive
Order 12549, Debarment and Suspension, 34 CFR Part 85, Section 85.510,
Participants' responsibilities.

A.  As the duly authorized representative of the applicant, I certify,
    to the best of my knowledge and belief, that neither the applicant
    nor its principals:

-   Is presently debarred, suspended, proposed for debarment, declared
    ineligible, or voluntarily excluded from covered transactions by any
    federal department or agency.

-   Has, within a three-year period preceding this application, been
    convicted of, or had an adverse civil judgment entered in connection
    with, fraud or other 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.

-   Is presently indicted for 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

-   Has not, within a three-year period preceding this application, had
    one or more public transactions (federal, state or local) terminated
    for cause or default.

B.  If you are unable to certify to any of the statements in this
    certification, you must attach an explanation to this application.

**Certification -- Drug-Free Workplace**

This certification is required by the regulations implementing the
Drug-Free Workplace Act of 1988, 34 CFR Part 85, Subpart F. The
regulations require certification by grantees, prior to award, 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 agency determined to award the grant. False certification or
violation of the certification may be grounds for suspension of
payments, suspension or termination of grants, or government-wide
suspension or debarment (see 34 CFR Part 85, Section 85.615 and 85.620).

As the duly authorized representative of the grantee, I certify, to the
best of my knowledge and belief, that the grantee will 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 a drug-free awareness program to inform employees
    about:

    -   The dangers of drug abuse in the workplace;

    -   The grantee's policy of maintaining a drug-free workplace;

    -   Any available drug counseling, rehabilitation, and employee
        assistance programs, and

    -   The penalties that may be imposed upon employees for drug abuse
        violations occurring in the workplace.

C.  Making it a requirement that each employee to be engaged in the
    performance of the grant be given a copy of the statement required
    by paragraph (A)

D.  Notifying the employee in the statement required by paragraph (A)
    that, as a condition of employment under the grant, the employee
    will:

-   Abide by the terms of the statement, and

-   Notify the employer of any criminal drug statute conviction for a
    violation occurring in the workplace no later than five days after
    such conviction.

E.  Notifying us within ten days after receiving notice under
    subparagraph (D) from an employee or otherwise receiving actual
    notice of such conviction.

F.  Taking one of the following actions, within 30 days of receiving
    notice under subparagraph (D) with respect to any employee who is so
    convicted:

-   Taking appropriate personnel action against such an employee, up to
    and including termination; or

-   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) through (F).

**Certification -- Lobbying Activities**

As required by Section 1352, Title 31 of the U.S. Code, as the duly
authorized representative of the applicant, I certify to the best of my
knowledge and belief that:

-   No federal appropriated funds have been paid or will be paid, by or
    on behalf of the applicant, to any person for influencing or
    attempting to influence an officer or employee of any agency, a
    member of Congress, an officer of Congress in connection with the
    awarding of any federal contract, the making of any federal loan,
    the entering into of any cooperative agreement or modification of
    any federal contract, grant, loan, or cooperative agreement.

-   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 applicant will submit Standard Form-LLL,
    "Disclosure Form to Report Lobbying," in accordance with its
    instructions.

-   The applicant will require that the language of this certification
    be included in the award documents for all subcontracts at all tiers
    (including subcontracts, subgrants, and contracts under grants,
    loans and cooperative agreements) and that all subrecipients will
    certify and disclose accordingly.

> **Certification -- Grant Review Process (State Commissions Only)**
>
> I certify that in conducting our review process, we have ensured
> compliance with the Agency's peer review requirements and all state
> laws and conflict of interest rules.