> **OMB Approval No. 0985-0018**

**Pension Counseling & Information Projects**

**Programmatic Supplement**

**Program Announcement and**

**Grant Application Instructions**

**U.S. Administration on Aging**

**2008**

**Department of Health and Human Services (HHS)**

**Administration on Aging (AoA)**

**AoA Center:** Center for Wellness and Community-Based Services

######## Funding Opportunity Title: Pension Counseling & Information Projects  {#funding-opportunity-title-pension-counseling-information-projects .unnumbered}

**Announcement Type:** initial

**Funding Opportunity Number:** HHS-2008-AoA-PC-0815

**Catalog of Federal Domestic Assistance (CFDA) Number:** 93.048

**Key Dates:** The deadline for receipt of applications is July 28, 2008

**Executive Summary:**

The Administration on Aging (AoA) plans to award up to five (5)
programmatic supplements to the five regional projects currently funded
under the Pension Counseling and Information Program. Therefore,
competition under this funding opportunity is limited to the following
organizations: Elder Law of Michigan, Inc., Legal Services for the
Elderly (New York), Legal Services of Northern California, Minnesota
Senior Federation, and University of Massachusetts Boston.

The intent of this program announcement is: 1) to enhance, through
supplemental funding, the pension counseling services being provided by
current grantees under the AoA Pension Counseling and Information
Program, and 2) to bring current grantee program requirements into
conformity with the 2008 Program Announcement for the AoA Pension
Counseling and Information Program:
<http://aoa.gov/doingbus/fundopp/announcements/2008/PCP_announcement_6-10-08.doc>.

Programmatic supplements, at a federal share of approximately \$ 42,500
each, will be awarded to those applicants who successfully respond to
this program announcement.

# FUNDING OPPORTUNITY DESCRIPTION 

**[Program History]{.underline}**

Since 1993, the Administration on Aging (AoA) has funded the Pension
Counseling and Information Program (the Program) to help individuals
understand and exercise their pension rights. The Program is founded
upon two service hallmarks: trustworthy and personalized assistance,
regardless of age, income or value of the pension claim; and,
broad-based expertise covering all employer-sponsored pension and
retirement savings plans, regardless of sponsor type (public, private)
or plan type (defined benefit, defined contribution).

Since its inception as a demonstration program under the Older Americans
Act, the AoA has worked to identify operational practices that
contribute most significantly to counseling projects' overall success.
This has resulted in a return on investment of more than \$5 in client
benefits for every federal dollar invested, as well as the Program's
permanence under the Older Americans Act. With this funding supplement,
AoA looks for continued and increased operational consistency across,
and cooperation within, the network of counseling projects and its
technical assistance provider.

**[Project Goals, Objectives and Activities]{.underline}**

The Program currently funds 5 multi-state, regional pension counseling
projects serving a total of 22 states at an annual operating budget per
project of approximately \$157,500 per project year. A sixth regional
pension counseling project grant will be competed and funded for a
two-year project period at approximately \$200,000 per year, under
amended program guidelines requiring expanded services, and increased
coordination with other regional counseling projects and the national
technical assistance project.

This supplemental funding announcement will bring current grantees into
alignment with the latest requirements for the AoA Pension Counseling
and Information Program guidelines. The following outline details only
the amendments, as denoted by italics, to the previous programmatic
guidelines (under which currently funded projects operate) that are the
focus of this supplemental funding opportunity.

Applicants should address in their proposals how they intend to use the
supplemental funds to meet the new requirements indicated in the
following italicized sections:

 

A.  [Regional Pension Counseling and Information Services]{.underline}.

    1.  [Counseling and Information Services]{.underline}.

a\. [Quick-Call Services]{.underline}:

b\. [Case Services]{.underline}:

> c\. [Referral Services]{.underline}: The purpose of a project's
> referral efforts is to build and utilize a cohesive region-wide
> network of private and public service providers to serve clients whose
> needs are outside the scope of counseling and information services. To
> meet this need, projects *must identify or establish region-wide, low-
> or no-cost referral networks. Applicants should detail their
> coordination with existing networks, such as the National Pension
> Lawyers Network, where available and appropriate. Referral services
> should cover the following areas:*
>
> *i. Employee benefits litigation;*
>
> *ii. Pension-related actuarial and accounting services;*
>
> *iii. Drafting and filing of Qualified Domestic Relations Orders
> (QDROs);*
>
> *iv. Counseling or advocacy services regarding health, disability, and
> other employer-sponsored welfare benefits*
>
> *v. Counseling or advocacy services regarding Social Security Old-Age,
> Survivors, and Disability Insurance (OASDI) program, and other public
> benefit or entitlement programs;*
>
> *vi. Financial education, and other retirement and estate planning
> services; and,*
>
> *vii. Elder rights and other consumer protection matters.*

2\. [Regional Service Delivery]{.underline}: All projects must be
regional, generally requiring that a proposed project must serve a
minimum of two (2) or more states (see exception, 2.b. below). Project
design must provide for equivalent access to services throughout the
region served (*such as through the use of a toll-free phone number,
website or other no cost mechanisms*). Projects must also ensure that
clients throughout the region served receive the same level and quality
of services, *regardless of their proximity to a physical project
office*. Preference in awarding funds will be given to applicants with
an evidenced capacity to deliver regional services.

3\. [Exclusive Subject Matter]{.underline}:

4.  [Individuals Served]{.underline}: Projects must provide equivalent
    services and equivalent access to those services to individuals,
    *regardless of age or income**,*** who:

    a.  Reside or work in the project's service region; or who

    b.  Worked or resided in the project's service region while earning
        a pension, or when married to an individual earning a pension;
        or who

    c.  Seek pension benefits that are sponsored, administered,
        trusteed, or are otherwise held or distributed by an entity that
        *is or was* headquartered or operated within the service region.

> B. [Regional Outreach Activities]{.underline}: Proposed projects must
> establish or maintain a plan for conducting a region-wide outreach
> effort to (1) maximize the intake of appropriate clients; and, (2) to
> build and maintain successful client-referral relationships with other
> information and service providers throughout the region served.
> Regional projects are responsible for outreach activities within their
> service region, while the national technical assistance project will
> coordinate activities at the national level. Project outreach must
> include the following objectives and activities:

1\. [Regional Intake and Referral Network]{.underline}:

a.  [Specialized Outreach Activities and Materials]{.underline}: The
    following considerations should also be addressed in the proposed
    regional outreach plan:

```{=html}
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```
i.  Project websites, brochures, fliers, and other outreach-related
    materials must clearly establish the specialty focus on pension
    assistance and information;

ii. Outreach materials (and overall project efforts) and activities
    address the breadth subject matter covered by the counseling
    projects, specifically including *competencies in both ERISA and
    non-ERISA pension systems*:

-   A portion of each project's outreach strategy must be specifically
    designed to increase the flow of clients under non-ERISA pension
    systems throughout the service region

-   Regional projects are responsible for developing fact sheets or
    other outreach materials covering plans or issues arising under
    state and local pension laws (based on client need).

-   Projects must utilize the national technical assistance project for
    developing fact sheets covering plans governed by or issues arising
    under federal pension laws (projects may amend these to cover
    regional variances or exceptions).

iii. A portion of each project's outreach strategy must be specifically
     targeted to reach underserved and hard-to-reach seniors, low-income
     seniors, and those with limited-English proficiency.

3\. [Media Relations]{.underline}:

4\. [Low and no-cost access]{.underline}:

5\. [Outreach events]{.underline}:

C. [Programmatic Consistency]{.underline}:

1\. [Staffing]{.underline}: Certain staffing models maximize both the
project's ability to provide the highest levels of counseling services,
as well as the project's breadth and depth of institutional experience
over time.

> a\. [Specialized Intake and Counseling Staff]{.underline}:
>
> b\. [Lawyers in Key Positions]{.underline}:
>
> c\. [Maximize Direct Access to "Live" Specialist Staff]{.underline}:
>
> d\. [Maximize Time Commitment of Volunteers, Law Students,
> etc.]{.underline}:
>
> e\. [Staff Development]{.underline}: Proposed staff development plans
> must include at least the following components:

i.  Specialist staff in each project location attend the annual Pension
    Counseling Project Training Conference in Washington, D.C. in each
    project year;

ii. At least two days of customized legal training and / or operational
    consultation and review at each project location will be delivered
    and/or coordinated by the national technical assistance project in
    each project year;

> *iii. Specialist staff will attend at least 6 credit hours of
> supplemental pension training (CLE) in each project year; and*
>
> *iv. Adequate budgetary resources to cover personnel time, tuition,
> travel and other expenses related to the project's staff development
> plan must be clearly delineated in the budget narrative.*
>
> f\. *[Infrastructure Development]{.underline}: The following elements
> have been identified as best practices which contribute significantly
> to project efficiency and effectiveness in line with Program goals and
> should, therefore, be allocated sufficient budget resources:*
>
> *i. [Pension Plan Information]{.underline}: Proposals should outline
> their existing hardware and software environment, and detail any
> additional technology necessary to electronically capture - with
> optical character recognition -- plan documents, summary plan
> descriptions and other governing plan instruments; and to share the
> electronic files with a central database (such as PensionHelp America)
> for redistribution to the larger pension counseling network.*
>
> *ii. [Computer Monitors]{.underline}: Proposals should also note
> whether their current computer monitors are optimized for viewing at a
> resolution of 1024 x 768 (or a minimum of 768 vertical pixels for
> widescreen or cinema displays); and whether these monitors are large
> enough to be viewed comfortably by project staff when set at this
> default resolution (this typically requires a 17" to 19" monitor --
> measured diagonally - at a minimum).*
>
> *ii.   [Pension Law Reference Resources]{.underline}: Proposals should
> outline the project's existing pension law library and detail any
> additional books, periodicals, and other reference materials necessary
> to competently research client matters across the full breadth of the
> project's regional and subject matter jurisdictions.*
>
> 2\. [Data Collection and Reporting]{.underline}: Data will be
> collected and reported in a manner consistent across all AoA-funded
> counseling projects. AoA will identify the baseline data set to be
> collected, and provide a low or no-cost tool to collect and report on
> that data. At a minimum the data set will include the number of
> clients served, client demographics, types and levels of services
> provided, legal issues presented, recoveries and other client
> outcomes, plan and sponsor types, and administrator contact
> information. Projects will collect and report data from each of their
> multiple locations (if applicable) and on the regional project's
> activities as a whole. All projects funded under this program will
> submit reports to the AoA and to the national technical assistance
> project for consolidation and analysis. Projects will be expected to
> collect and retain documents and contact information for the pension
> plans they identify in their casework and share this information with
> the national technical assistance project *for redistribution to the
> broader pension counseling network. Current plan, sponsor and contact
> information will be electronically collected and transferred to a
> centralized database, under the guidance of the technical assistance
> center. Primary focus will be on those plans that are traditionally
> the most difficult for deferred vested participants to find,
> including:*

-   *Defined benefit plans terminated prior to July 1, 1974;*

-   *Terminated / orphaned defined contribution plans (prior to 2009);*

-   *Other plans that have experienced a change in sponsor name or
    location, or operational status.*

> *Proposals should ensure that adequate budgetary resources are
> dedicated for personnel, hardware, software or other resources to
> ensure accurate and timely collection of project data.*
>
> 3\. [Shared Learning]{.underline}: Projects are expected to build on
> the experience of existing pension counseling projects and to share
> their insights regarding client casework, outreach and project
> operations with other pension counseling projects and the national
> technical assistance project. No-cost tools such as the AoA Pension
> Counseling Listserv are available for this purpose. Proposals should
> detail a *methodology for accessing, learning from and contributing to
> the pension counseling program's shared learning environment.*

### Statutory Authority  {#statutory-authority .unnumbered}

The statutory authority for grants under this program announcement is
contained in Title II, Section 215 of the Older Americans Act (OAA)
(42U.S.C. 3032), as amended in 2006 (P.L. 109-365).

# AWARD INFORMATION 

Award Type: grant, programmatic supplemental

Estimated Federal Funds Available: \$212,500

Estimated Number of Awards: 5 (five)

Average Projected Award Amount: Up to \$ 42,500

Anticipated Project Start Date: No later than September 30, 2008

Budget Period: One year

## III. ELIGIBILITY INFORMATION {#iii.-eligibility-information .unnumbered}

######## 1. Eligible Applicants  {#eligible-applicants .unnumbered}

The purpose of this award is to enhance pension counseling services
currently being provided by grantees under the Administration on Aging
Pension Counseling & Information Program. Therefore, competition under
this program announcement is limited to the following organizations:
Elder Law of Michigan, Inc., Legal Services for the Elderly (New York),
Legal Services of Northern California, Minnesota Senior Federation, and
University of Massachusetts Boston.

**2. Cost Sharing or Matching**

Under this Older Americans Act program, AoA will fund no more than 75%
of the project's total cost, which means the applicant must cover at
least 25% of the project's total cost with non-federal resources. In
other words, for every three (3) dollars received in federal funding,
the applicant must contribute at least one (1) dollar in non-federal
resources toward the project's total cost, as reflected in the formula
included under Item 18 in Attachment A. You can use this formula to
calculate your minimum required match. A common error applicants make is
to match 25% of the federal share, rather than 25% of the project's
total cost. In addition, successful applicants will be accountable for
all proposed match, including that above the minimum requirement.

######## 3. Application Screening Criteria {#application-screening-criteria .unnumbered}

All applications will be screened to assure a level playing field for
all applicants. Applications that fail to meet the screening criteria
described below will **[not]{.underline}** be reviewed and will receive
**[no]{.underline}** further consideration.

In order for an application to be reviewed, it must meet the following
screening requirements:

1.  Applications must be submitted electronically via
    [www.grants.gov](http://www.grants.gov/) by 11:59 p.m., Eastern
    Time, July 28, 2008.

2.  The Project Narrative section of the Application **[must be
    double-spaced]{.underline}**, on 8 ½" x 11" plain white paper with
    1" margins on both sides, and a font size of not less than 11.

3.  The Project Narrative **must [not]{.underline} exceed 12 pages**.

## IV. APPLICATION AND SUBMISSION INFORMATION {#iv.-application-and-submission-information .unnumbered}

All applicants are required to submit electronically through
[http://www.grants.gov](http://www.grants.gov/) by 11:59 p.m., Eastern
time, July 28, 2008.

######## 1. Address to Request Application Package  {#address-to-request-application-package .unnumbered}

Application materials can be obtained from
[http://www.grants.gov](http://www.grants.gov/) or
<http://www.aoa.gov/doingbus/fundopp/fundopp.asp>.

Application materials are also available by writing to:

> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Valerie Soroka
>
> Office of Elder Rights
>
> Washington, D.C. 20201
>
> Or by calling: 202-357-3531
>
> Or e-mailing: valerie.soroka@aoa.hhs.gov

Please note: AoA is requiring applications for this announcement to be
submitted electronically through
[www.grants.gov](http://www.grants.gov/). The Grants.gov registration
process can take several days. If your organization is not currently
registered with [www.grants.gov](http://www.grants.gov/), please begin
this process immediately. **For assistance with
[www.grants.gov](http://www.grants.gov/), please contact them at**
[support@grants.gov](mailto:support@grants.gov?subject=Support) **or
1-800-518-4726 between 7 a.m. and 9 p.m. Eastern Time.** At
[www.grants.gov](http://www.grants.gov/), you will be able to download a
copy of the application packet, complete it off-line, and then upload
and submit the application via the Grants.gov website.

Basic information and instructions for applications submitted via
[www.grants.gov](http://www.grants.gov/) include the following:

-   You may access the electronic application for this program on
    [www.Grants.gov](http://www.Grants.gov/). You must search the
    downloadable application page by the Funding Opportunity Number
    (HHS-2008-AoA-PC0810) or CFDA number (93.048).

-   At the www.grants.gov website, you will find information about
    submitting an application electronically through the site, including
    the hours of operation. AoA strongly recommends that you do not wait
    until the application due date to begin the application process
    through [www.grants.gov](http://www.grants.gov/) because of the time
    delay.

-   All applicants must have a Dun and Bradstreet (D&B) Data Universal
    Numbering System number (DUNS) and register in the Central
    Contractor Registry (CCR). You should allow a minimum of **five
    days** to complete the CCR registration.

-   You must submit all documents electronically, including all
    information included on the SF 424 and all necessary assurances and
    certifications.

-   Prior to application submission, **Microsoft Vista and Office 2007
    users** should review the grants.gov compatibility information and
    submission instructions provided at
    [www.grants.gov](http://www.grants.gov/) (click on "Vista and
    Microsoft Office 2007 Compatibility Information").

-   **[Your application must comply with any page limitation
    requirements described in this program announcement]{.underline}.**

-   After you electronically submit your application, you will receive
    an automatic acknowledgement from www.grants.gov that contains a
    Grants.gov tracking number. The Administration on Aging will
    retrieve your application form from Grants.gov.

-   We may request that you provide original signatures on forms at a
    later date.

-   Each year organizations registered to apply for federal grants
    through [www.grants.gov](http://www.grants.gov/) will need to renew
    their registration with the Central Contractor Registry (CCR). You
    can register with the CCR online and it will take about 30 minutes
    ([www.grants.gov/CCRRegister](http://www.grants.gov/CCRRegister)).

######## 2. Content and Form of Application Submission  {#content-and-form-of-application-submission .unnumbered}

######## a. DUNS Number  {#a.-duns-number .unnumbered}

The Office of Management and Budget requires applicants to provide a Dun
and Bradstreet (D&B) Data Universal Numbering System (DUNS) number when
applying for Federal grants or cooperative agreements on or after
October 1, 2003. It is entered on the SF 424. It is a unique,
**nine-digit identification number**, which provides unique identifiers
of single business entities. The DUNS number is *free and easy* to
obtain.

Organizations can receive a DUNS number at no cost by calling the
dedicated toll-free DUNS Number request line at 1-866-705-5711 or by
using this link:
<https://www.whitehouse.gov/omb/grants/duns_num_guide.pdf>.

######## b. Project Narrative {#b.-project-narrative .unnumbered}

The Project Narrative must be double-spaced, on 8 ½" x 11" paper with 1"
margins on both sides, and a font size of not less than 11. You can use
smaller font sizes to fill in the Standard Forms and Sample Formats. The
suggested length for the Project Narrative is eight to twelve pages;
twelve pages is the maximum length allowed. **[AoA will not accept
applications with a Project Narrative that exceeds 12
pages]{.underline}.**

The components counted as part of the 12 page limit include:

-   Summary/Abstract

-   Problem Statement

-   Goal(s) and Objective(s)

-   Proposed Intervention

-   Special Target Populations and Organizations

-   Outcomes

-   Project Management

-   Evaluation

-   Dissemination

-   Organizational Capability

The Project Narrative is the most important part of the application,
since it will be used as the primary basis to determine whether or not
your project meets the minimum requirements for grants under Title IV of
the Older Americans Act. The Project Narrative should provide a **clear
and concise** description of your project. AoA recommends that your
project narrative include the following components:

**[Summary/Abstract]{.underline}.** This section should include a brief
-- no more than 265 words maximum - description of the proposed
intervention and activities, including: the goal, priority area(s),
target population, activities, and measurable outcomes. Detailed
instructions for completing the summary/abstract are included in
Attachment E of this document. *Applicants should amend their originally
funded Summary/Abstract as necessary to reflect any enhancements made
possible through this supplement.*

**[Problem Statement]{.underline}.** This section should describe, in
both quantitative and qualitative terms, the nature and scope of the
particular problem or issue the proposed intervention is designed to
address. Specifically, provide a concise description of your current
pension counseling project's activities in each of the project
enhancement areas outlined below. If your project is not currently
engaged in activities that address a particular enhancement area, state
"no activities are currently being undertaken."

1\. [Regional Services]{.underline}.

> a\. Region-wide referral networks addressing identified areas.

a.  Client access to regional service delivery through a toll-free
    number, website or other no-cost mechanism.

b.  Equivalent services and service levels to clients throughout the
    region:

    i.  regardless of their proximity to a physical project office;

    ii. regardless of their age or income;

> and who

iii. have a connection to the region served based on current or past:
     client residency, employment, or marital history; plan sponsor
     operations; or plan administration.

> 2\. [Specialized Outreach Activities and Materials]{.underline}:
> Regional outreach materials and activities that emphasize the
> project's competencies in target potential clients under ERISA and
> non-ERISA pension systems.
>
> 3\. [Staff Development]{.underline}:

a\. Specialist staff attendance at annual Pension Counseling Training
Conference in Washington, D.C.;

b\. On-site legal training or operational consultation by the national
technical assistance project;

iii\. Specialist staff attendance at supplemental pension training (CLE)
events; and

iv\. Adequate resources dedicated to pension counseling staff
development.

> 4\. [Data Collection and Reporting]{.underline}:
>
> a\. Data is collected and reported in a manner consistent across all
> AoA-funded counseling projects. Reported data includes at least the
> number of clients served, client demographics, types and levels of
> services provided, legal issues presented, recoveries and other client
> outcomes, plan and sponsor types, and administrator contact
> information.
>
> b\. Data is collected and reported from each of the project's multiple
> locations (if applicable) and on the regional project's activities as
> a whole.
>
> c\. Reports are submitted to AoA and to the technical assistance
> project for consolidation and analysis.
>
> d\. Plan documents are collected and retained; and pension plan
> documents and contact information is electronically shared with the
> national technical assistance center.
>
> 5\. [Pension Law Reference Resources]{.underline}:
>
> 6\. [Shared Learning]{.underline}:
>
> 7\. [Other Project Enhancements]{.underline}: Identify any additional
> issues or challenges that your regional counseling project faces that
> can be addressed by this supplemental funding.

**[Goal(s) and Objectives]{.underline}.** This section should consist of
a description of the project's goal(s) and major objectives in terms of
the priority area(s). In responding to this announcement, we recommend
that you identify as project goals, those elements from your "Problem
Statement" that the proposed supplement will address. Goals and
objectives should be the difference between your project evaluation from
the "Problem Statement" and full alignment with each of the program
guideline enhancement areas (regional services, specialized outreach,
staff development, data collection and reporting, etc.), noting each
objective's impact on the project both in terms of expanded regional
services to clients, and expanded project contribution to the Program as
a whole.

**[Proposed Intervention]{.underline}.** This section should provide a
clear and concise description of the intervention, methodology, and
activities you are proposing to accomplish your identified goals and
objectives.

**[Special Target Populations and Organizations]{.underline}.** This
section should describe how the proposed intervention will affect
vulnerable populations, specifically relating to identifying and
responding to the need for pension counseling services among
disadvantaged, hard-to-reach, and limited-English speaking populations.

**[Outcomes]{.underline}**. This section of the project narrative must
clearly identify the [measurable]{.underline} outcome(s) that will
result from the proposed intervention. (NOTE: AoA will not fund any
project that does not include measurable outcomes). This section should
also describe how the project's findings might benefit the field at
large, (e.g., how the findings could help other organizations throughout
the nation to address the same or similar problems). List measurable
outcomes in the attached Work Plan Grid (Attachment D) under "Measurable
Outcomes" in addition to any discussion included in the narrative along
with a description of how the project might benefit the field at large.

A "measurable outcome" is an observable end-result that describes how a
particular intervention benefits consumers. It can describe a change in
the degree of customer satisfaction; a change in the responsiveness or
cost-effectiveness of a service delivery system; an increase in access
to service for previously underserved target groups; a measurable
increase in awareness, skills, and behaviors that result in protection
of the financial security and consumer rights of elders; a measurable
improvement in seniors' financial, emotional, physical, and mental
well-being; or an increase in the number of cases closed with a
favorable result for the client.

A measurable outcome is not a measurable "output" such as: the number of
clients served; the number of training sessions held; the number of
informational materials disseminated; or the number of service units
provided.

Applicants should present those measurable outcomes from the originally
funded application that are relevant to this supplement, highlighting
any changes necessitated by this supplement; as well as any new
measurable outcomes made possible through this supplement.

**[Project Management]{.underline}**. This section should describe only
those original elements of your originally funded project management
plan that are amended or expanded by this supplement; as well as any new
project management components necessitated by this supplement.

**[Evaluation]{.underline}**. This section should describe only those
original elements of your originally funded evaluation proposal that are
amended or expanded by this supplement; as well as any new evaluative
components necessitated by this supplement.

**[Dissemination]{.underline}.** This section should describe only those
original elements of your originally funded dissemination plan that are
amended or expanded by this supplement; as well as any new dissemination
components necessitated by this supplement.

**[Organizational Capability Statement]{.underline}.** This section
should describe only those original elements of your originally funded
organizational capability statement that are amended or expanded by this
supplement; as well as any new organizational components necessitated by
this supplement.

######## Attachments {#attachments .unnumbered}

########  {#section .unnumbered}

######## [Work Plan]{.underline}. The Project Work Plan should reflect, and be consistent with, the Project Narrative and Budget. It should include a statement of the project's overall goal, anticipated outcome(s), key objectives, and the major tasks/action steps that will be pursued to achieve the goal and outcome(s). For each major task/action step, the work plan should identify timeframes involved (including start --and end-dates), and the lead person responsible for completing the task. Please use the Sample Work Plan format including in the Attachments.  {#work-plan.-the-project-work-plan-should-reflect-and-be-consistent-with-the-project-narrative-and-budget.-it-should-include-a-statement-of-the-projects-overall-goal-anticipated-outcomes-key-objectives-and-the-major-tasksaction-steps-that-will-be-pursued-to-achieve-the-goal-and-outcomes.-for-each-major-taskaction-step-the-work-plan-should-identify-timeframes-involved-including-start-and-end-dates-and-the-lead-person-responsible-for-completing-the-task.-please-use-the-sample-work-plan-format-including-in-the-attachments. .unnumbered}

**[Budget Narrative.]{.underline}** The Budget Narrative should be
provided using the format included as Attachment C of this Program
Announcement. Applicants are encouraged to pay particular attention
to Attachment B which provides an example of the level of detail
sought.  Please note that when more than 33% of a project's budget falls
under contractual, detailed budget narratives must be provided for each
sub-contractor or sub-grant. 

######## 3. Submission Dates and Times  {#submission-dates-and-times .unnumbered}

The deadline for the submission of applications under this program
announcement is July 28, 2008. Applications must be submitted
electronically by 11:59 P.M., July 28, 2008.

Applications that fail to meet the application due date will
**[not]{.underline}** be reviewed and will receive **[no]{.underline}**
further consideration.

Grants.gov will automatically send applicants a tracking number and date
of receipt verification electronically once the application has been
successfully received and validated in Grants.gov.

######## 4. Intergovernmental Review {#intergovernmental-review .unnumbered}

This funding opportunity announcement is not subject to the requirements
of Executive Order 12372, "Intergovernmental Review of Federal
Programs."

######## 5. Funding Restrictions {#funding-restrictions .unnumbered}

The following activities are not fundable:

-   Construction and/or major rehabilitation of buildings

-   Basic research (e.g. scientific or medical experiments)

-   Continuation of existing projects without expansion or new and
    innovative

> approaches

########  6. Other Submission Requirements  {#other-submission-requirements .unnumbered}

Electronic submissions must be sent to:
[http://www.grants.gov](http://www.grants.gov/).

Applicants submitting their application through
[www.grants.gov](http://www.grants.gov/) must register in the Central
Contractor Registry (CCR) database in order to be able to submit the
application. One element of the CCR is the DUNS number (see section
IV.2), which must be obtained separately from CCR registration.
Information about CCR is available at
<http://www.grants.gov/CCRRegister>. You must also register with a
Credential Provider to receive a username and password to securely
submit your grant application. Information is available at
<http://www.grants.gov/CredentialProvider> .

######## V. APPLICATION REVIEW INFORMATION  {#v.-application-review-information .unnumbered}

######## 1. Criteria  {#criteria .unnumbered}

Applications are scored by assigning a maximum of 100 points across four
criteria:

-   Purpose and Need for Assistance - (25 points);

-   Approach, Workplan and Activities - (30 points);

-   Outcomes/Evaluation/Dissemination - (20 points); and

-   Level of Effort - (25 points).

  ------------------------------------------------------ ---------------------
  a\. [Purpose and Need for Assistance]{.underline}      [Weight: 25
                                                         points]{.underline}

                                                         
  ------------------------------------------------------ ---------------------

i.  [Purpose and Need]{.underline}: Is the problem as identified for the
    region and general populations consistent with the AoA Program
    purpose, as described in Section I of this Program Announcement?
    Does the applicant's assessment of current activities adequately
    clarify the need for the supplement? Are the "purpose and need"
    themes, as identified, appropriately and thoughtfully addressed
    throughout the proposal? (20 points)

ii. [Targeting]{.underline}: To the extent that targeting is
    necessitated by this supplement: Does the applicant identify and
    prioritize any target populations within their region? Does the
    applicant clearly identify and substantiate the target population's
    need for pension counseling services? Is the problem as identified
    for target populations consistent with the AoA Program purpose? (5
    points)

  ------------------------------------------------------ ---------------------
  b\. [Approach, Work Plan and Activities]{.underline}   [Weight: 30
                                                         points]{.underline}

  ------------------------------------------------------ ---------------------

i.  [Overall Approach]{.underline}: Does the applicant present a well
    thought out approach, consistent with AoA's program goals? Are the
    proposed goals and objectives clearly driven by the "Problem
    Statement?" Is the proposed intervention appropriately driven by the
    project's goals and objectives? (10 points)

ii. [Work Plan and Activities]{.underline}: Is the project work plan
    clear, comprehensive, and directly related to both AoA's program
    purpose and to the proposed project's activities? Does it include
    sensible and feasible timeframes for the accomplishment of tasks
    presented? Does the work plan include specific objectives and tasks
    that are linked to measurable outcomes? Are the roles and
    responsibilities of project staff, consultants, and partners clearly
    defined and linked to specific objectives and tasks? Has the
    applicant adequately planned for the appropriate training and
    technical support necessary for project staff, regional affiliates,
    and identified intake and support networks? Has the applicant
    planned for the involvement of the national technical assistance
    project in facilitating the execution of its work plan? (20 points)

c\. [Project Outcomes, Evaluation, and Dissemination]{.underline}
[Weight: 20 points]{.underline}

i.  [Outcomes]{.underline}: Are the expected project benefits and
    results clear, realistic, and consistent with both AoA's program
    purpose and the objectives of the proposed project? Are the
    anticipated outcomes of the proposed project likely to be achieved,
    and will they significantly assist individuals in understanding and
    enforcing their pension rights? Are the proposed outcomes
    quantifiable and measurable, consistent with the definition of a
    project outcome contained in Section IV.2.b. of the Program
    Announcement? (10 points)

ii. [Evaluation]{.underline}: Does the approach adequately measure
    whether or not the project has achieved AoA's goals and objectives,
    as well as the project's proposed outcome(s)? Is the evaluation
    designed to capture and communicate "lessons learned" that might be
    of use to others in the pension counseling community, or those
    interested in replicating the project? (5 points)

iii. [Dissemination]{.underline}: Will the dissemination plan get
     relevant and easy-to-use information in a timely manner to parties
     that might be interested in making use of its findings,
     particularly to those who might want to replicate the project? Does
     the proposal detail a plan for sharing its findings with all
     appropriate audiences? (5 points)

d\. [Level of Effort]{.underline} [Weight: 25 points]{.underline}

i.  [Capacity]{.underline}: Is the applicant organization, its staff and
    affiliates, sufficiently knowledgeable of pension law, regional
    service delivery, and the range of required counseling, outreach and
    support services to efficiently and effectively undertake the
    proposed intervention? Has the applicant demonstrated capacity and
    experience in using quantitative and/or qualitative performance
    outcome information to support its activity and management
    decisions? (5 points)

ii. [Staffing]{.underline}: Is the time commitment of project staff,
    consultants, and/or partners appropriate and adequate to carry out
    the project? Is the time commitment of the proposed director and
    other key project personnel sufficient to assure proper direction,
    management, and timely completion of the project? (5 points)

iii. [Budget]{.underline}: Is the project cost-effective and
     programmatically efficient, maximizing Federal and all other
     resources? Is the budget justified with respect to the adequacy and
     reasonableness of resources requested? Are budget line items
     clearly delineated and consistent with work plan objectives and the
     AoA Program purpose? (15 points)

######## 2. Review and Selection Process  {#review-and-selection-process .unnumbered}

########   {#section-1 .unnumbered}

An independent review panel of at least three individuals will evaluate
applications that pass the screening and meet the responsiveness
criteria if applicable. These reviewers are experts in their field, and
are drawn from academic institutions, non-profit organizations, state
and local government, and federal government agencies. Based on the
specific programmatic considerations as outlined under section I,
Funding Opportunity Description, the reviewers will comment on and score
the applications, focusing their comments and scoring decisions on the
criteria identified above.

Final award decisions will be made by the Assistant Secretary for Aging
(ASA). In making these decisions, the ASA will take into consideration:
recommendations of the review panel; evidenced capacity of the applicant
to deliver regional services; reviews for programmatic and grants
management compliance; the reasonableness of the estimated cost to the
government considering the available funding and anticipated results;
and the likelihood that the proposed project will result in the benefits
expected.

Applicants have the option of omitting from the application specific
salary rates or Social Security Numbers for individuals specified in the
application budget.

## VI. AWARD ADMINISTRATION INFORMATION {#vi.-award-administration-information .unnumbered}

######## 1. Award Notices  {#award-notices .unnumbered}

Successful applicants will receive an Approval Letter, and a Notice of
Award. The Notice of Award is the authorizing document, and will be
signed by the AoA grants management officer, the AoA authorizing
official, and the AoA budget office. Unsuccessful applicants are
notified within 30 days of the final funding decision and will receive a
disapproval letter via U.S. mail.

######## 2. Administrative and National Policy Requirements  {#administrative-and-national-policy-requirements .unnumbered}

The award is subject to DHHS Administrative Requirements, which can be
found in 45CFR Part 74 and 92 and the Standard Terms and Conditions
implemented through the HHS Grants Policy Statement, located at
http://www.hhs.gov/grantsnet/adminis/gpd/index.htm.

######## 3. Reporting  {#reporting .unnumbered}

The SF-269 (Financial Status Report) is due annually and the AoA program
progress report is due semi-annually. Final performance and SF-269
reports are due 90 days after the end of the project period. The final
performance report will replace the final semi-annual report. However,
the final performance report should include a discussion of the
activities, progress, and achievements from the last 6 months of the
project along with a summary of the overall project.

## VII. AGENCY CONTACTS  {#vii.-agency-contacts .unnumbered}

Project Officer:

U.S. Department of Health and Human Services

Administration on Aging

Washington, DC 20201

Attn: Valerie Soroka

Telephone: (202) 357-3531, e-mail: <valerie.soroka@aoa.hhs.gov>

Director, Office of Grants Management:

U.S. Department of Health and Human Services

Administration on Aging

Washington, DC 20201

Attn: Sean Lewis

Telephone: (202) 357-3445, e-mail: <Sean.lewis@aoa.hhs.gov>

## VIII. OTHER INFORMATION {#viii.-other-information .unnumbered}

###### A. Application Elements {#a.-application-elements .unnumbered}

To expedite the processing of applications, we request that you arrange
the components of your application in the following order:

1.  SF 424 -- Application for Federal Assistance.

2.  SF 424A -- Budget Information.

3.  Separate Budget Narrative/Justification (See Attachments for Sample
    Format).

4.  SF 424B -- Assurances. Note: Be sure to complete this form according
    to instructions and have it signed and dated by the authorized
    representative (see item 18d on the SF 424).

5.  Certification

6.  Proof of non-profit status

7.  Copy of the applicant\'s most recent indirect cost agreement, as
    necessary.

8.  Project Narrative with Work Plan (See Attachment for Sample Work
    Plan Format).

9.  Organizational Capability Statement and Vitae for Key Project
    Personnel.

10. Letters of Commitment from Key Partners.

11. "Survey on Ensuring Equal Opportunity for Applicants" (Optional
    non-profit applicants)

###### B. The Paperwork Reduction Act of 1995 (P.L. 104-13) {#b.-the-paperwork-reduction-act-of-1995-p.l.-104-13 .unnumbered}

An agency 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.

The project description and budget justification is approved under OMB
control number 0985-0018.

######## Public reporting burden for this collection of information is estimated to average 10 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed and reviewing the collection information.  {#public-reporting-burden-for-this-collection-of-information-is-estimated-to-average-10-hours-per-response-including-the-time-for-reviewing-instructions-gathering-and-maintaining-the-data-needed-and-reviewing-the-collection-information. .unnumbered}

**ATTACHMENTS**

**Attachment A:**

**Instructions for completing the SF 424, Budget (SF 424A), Budget
Narrative and Other Required Forms**

**Attachment B:**

**Budget Justification Format -- Sample Format with Examples**

**Attachment C:**

**Budget Justification -- Sample Format**

**Attachment D:**

**Project Work Plan - Sample Format**

**Attachment E:**

**Instructions for Completing the Summary/Abstract**

**Attachment F:**

**"Survey on Ensuring Equal Opportunity for Applicants"**

# Attachment A {#attachment-a .unnumbered}

# Instructions for completing the SF 424, Budget (SF 424A), Budget Narrative, and Other Required Forms {#instructions-for-completing-the-sf-424-budget-sf-424a-budget-narrative-and-other-required-forms .unnumbered}

  -----------------------------------------------------------------------
  This section provides step-by-step instructions for completing the four
  (4) standard federal forms required as part of your grant application,
  including special instructions for completing Standard Budget Forms 424
  and 424A. Standard Forms 424 and 424A are used for a wide variety of
  federal grant programs, and federal agencies have the discretion to
  require some or all of the information on these forms. AoA does not
  require all the information on these Standard Forms. Accordingly,
  please use the instructions below in lieu of the standard instructions
  attached to SF 424 and 424A to complete these forms.

  -----------------------------------------------------------------------

###### a. Standard Form 424 {#a.-standard-form-424 .unnumbered}

1\. **Type of Submission:** (Required): Select one type of submission in
accordance with agency instructions.

• Preapplication • Application • Changed/Corrected Application -- If AoA
requests, check if this submission is to change or correct a previously
submitted application.

2\. **Type of Application**: (Required) Select one type of application
in accordance with agency instructions.

• New . • Continuation • Revision

3\. **Date Received:** Leave this field blank.

4\. **Applicant Identifier**: Leave this field blank

5a **Federal Entity Identifier**: Leave this field blank

5b. **Federal Award Identifier**: For new applications leave blank. For
a continuation or revision to an existing award, enter the previously
assigned Federal award (grant) number.

6\. **Date Received by State:** Leave this field blank.

7\. **State Application Identifier:** Leave this field blank.

8\. **Applicant Information**: Enter the following in accordance with
agency instructions:

**a. Legal Name**: (Required): Enter the name that the organization has
registered with the Central Contractor Registry. Information on
registering with CCR may be obtained by visiting the Grants.gov website.

**b. Employer/Taxpayer Number (EIN/TIN):** (Required): Enter the
Employer or Taxpayer Identification Number (EIN or TIN) as assigned by
the Internal Revenue Service.

**c. Organizational DUNS**: (Required) Enter the organization's DUNS or
DUNS+4 number received from Dun and Bradstreet. Information on obtaining
a DUNS number may be obtained by visiting the Grants.gov website.

**d. Address**: (Required) Enter the complete address including the
county.

**e. Organizational Unit:** Enter the name of the primary organizational
unit (and department or division, if applicable**)** that will undertake
the project.

**f. Name and contact information of person to be contacted on matters
involving this application**: Enter the name (First and last name
required), organizational affiliation (if affiliated with an
organization other than the applicant organization), telephone number
(Required), fax number, and email address (Required) of the person to
contact on

matters related to this application.

9\. **Type of Applicant:** (Required) Select the applicant organization
"type" from the following drop down list.

A. State Government B. County Government C. City or Township Government
D. Special District Government E. Regional Organization F. U.S.
Territory or Possession G. Independent School District H. Public/State
Controlled Institution of Higher Education I. Indian/Native American
Tribal Government (Federally Recognized) J. Indian/Native American
Tribal Government (Other than Federally Recognized) K. Indian/Native
American Tribally Designated Organization L. Public/Indian Housing
Authority M. Nonprofit with 501C3 IRS Status (Other than Institution of
Higher Education) N. Nonprofit without 501C3 IRS Status (Other than
Institution of Higher Education) O. Private Institution of Higher
Education P. Individual Q. For-Profit Organization (Other than Small
Business) R. Small Business S. Hispanic-serving Institution T.
Historically Black Colleges and Universities (HBCUs) U. Tribally
Controlled Colleges and Universities (TCCUs) V. Alaska Native and Native
Hawaiian Serving Institutions W. Non-domestic (non-US) Entity X. Other
(specify)

10\. **Name Of Federal Agency**: (Required) Enter U.S. Administration on
Aging

11\. **Catalog Of Federal Domestic Assistance Number/Title:** The CFDA
number can be found on page one of the Program Announcement.

12\. **Funding Opportunity Number/Title:** (Required) The Funding
Opportunity Number and title of the opportunity can be found on page one
of the program announcement.

13\. **Competition Identification Number/Title:** Leave this field
blank.

14\. **Areas Affected By Project:** List the largest political entity
affected (cities, counties, state etc).

15\. **Descriptive Title of Applicant's Project:** (Required) Enter a
brief descriptive title of the project.

16\. **Congressional Districts Of**: (Required) 16a. Enter the
applicant's Congressional District, and 16b. Enter all district(s)
affected by the program or project. Enter in the format: 2 characters
State Abbreviation -- 3 characters District Number, e.g., CA-005 for
California 5th district, CA-012 for California 12^th^ district, NC-103
for North Carolina's 103rd district. • If all congressional districts in
a state are affected, enter "all" for the district number, e.g., MD-all
for all congressional districts in Maryland. • If nationwide, i.e. all
districts within all states are affected, enter US-all.

17\. **Proposed Project Start and End Dates**: (Required) Enter the
proposed start date and end date of the project.

18\. **Estimated Funding:** (Required) Enter the amount requested or to
be contributed during the first funding/budget period by each
contributor. Value of in-kind contributions should be included on
appropriate lines, as applicable. If the action will result in a dollar
change to an existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses.

**NOTE:** Applicants should review cost sharing or matching principles
contained in Subpart C of 45 CFR Part 74 or 45 CFR Part 92 before
completing Item 18 and the Budget Information Sections A, B and C noted
below.

All budget information entered under item 18 should cover the upcoming
budget period. For sub-item 18a, enter the federal funds being
requested. Sub-items 18b-18e is considered matching funds. The dollar
amounts entered in sub-items 18b-18f must total at least 1/3^rd^ of the
amount of federal funds being requested (the amount in 18a). For a full
explanation of AoA's match requirements, see the information in the box
below. For sub-item 18f, enter only the amount, if any, that is going to
be used as part of the required match.

There are two types of match: 1.) non-federal cash and 2.) non-federal
non-cash (i.e., in-kind). In general, costs borne by the applicant and
cash contributions of any and all third parties involved in the project,
including sub-grantees, contractors and consultants, are considered
[cash matching funds]{.underline}. Generally, most contributions from
third parties will be non-cash (i.e., in-kind) matching funds. Examples
of [non-cash (in-kind) match]{.underline} include: volunteered time and
use of facilities to hold meetings or conduct project activities.

NOTE: **Indirect charges** may only be requested if: (1) the applicant
has a current indirect cost rate agreement approved by the Department of
Health and Human Services or another federal agency; or (2) the
applicant is a state or local government agency. State governments
should enter the amount of indirect costs determined in accordance with
DHHS requirements. **If indirect costs are to be included in the
application, a copy of the approved indirect cost agreement must be
included with the application.**

19\. **Is Application Subject to Review by State Under Executive Order
12372 Process?** Check c. Program is not covered by E.O. 12372

20\. **Is the Applicant Delinquent on any Federal Debt?** (Required)
This question applies to the applicant organization, not the person who
signs as the authorized representative. If yes, include an explanation
on the continuation sheet.

21\. **Authorized Representative**: (Required) To be signed and dated by
the authorized representative of the applicant organization. Enter the
name (First and last name required) title (Required), telephone number
(Required), fax number, and email address (Required) of the person
authorized to sign for the applicant. A copy of the governing body's
authorization for you to sign this application as the official
representative must be on file in the applicant's office. (Certain
Federal agencies may require that this authorization be submitted as
part of the application.)

**b. Standard Form 424A**

+-----------------------------------------------------------------------+
| > NOTE: Standard Form 424A is designed to accommodate applications    |
| > for multiple grant programs; thus, for purposes of this AoA         |
| > program, many of the budget item columns and rows are not           |
| > applicable. You should only consider and respond to the budget      |
| > items for which guidance is provided below. Unless otherwise        |
| > indicated, the SF 424A should reflect a one year budget.            |
+-----------------------------------------------------------------------+

##### Section A ‑ Budget Summary {#section-a-budget-summary .unnumbered}

> [Line 5]{.underline}: Leave columns ( c) and (d) blank. Enter TOTAL
> federal costs in column (e) and total non‑federal costs (including
> third party in‑kind contributions and any program income to be used as
> part of the grantee match) in column (f). Enter the sum of columns (e)
> and (f) in column (g).

##### Section B ‑ Budget Categories {#section-b-budget-categories .unnumbered}

> Column 3: Enter the breakdown of how you plan to use the federal funds
> being
>
> requested by object class category (see instructions for each object
> class category below).
>
> Column 4: Enter the breakdown of how you plan to use the non-federal
> share by object class category.
>
> Column 5: Enter the total funds required for the project (the sum of
> Columns 3 and 4) by object class category.

+-----------------------------------------------------------------------+
| ###### Separate Budget Narrative/Justification Requirem               |
| ent {#separate-budget-narrativejustification-requirement .unnumbered} |
|                                                                       |
| > You must submit a separate budget narrative as part of your         |
| > application. **A blank sample format (and one with examples) has    |
| > been included in the attachments for your use in developing and     |
| > presenting your Budget Narrative.** In your budget justification,   |
| > you should include a breakdown of the budget which shows the costs  |
| > for all of the object class categories noted in Section B, across   |
| > three columns: federal; non-federal cash; and non-federal in-kind.  |
| > The justification should fully explain and justify the costs in     |
| > each of the major budget items for each of the object class         |
| > categories, as described below. Third party in-kind contributions   |
| > designated as non-federal match contributions should be clearly     |
| > identified and justified separately from the justification for the  |
| > budget line items. The full budget justification should be included |
| > in the application immediately following the SF 424 forms. **The    |
| > budget justification should provide a detailed breakdown of large   |
| > dollar values. A separate budget justification must be completed    |
| > for each year of support requested.**                               |
+-----------------------------------------------------------------------+

> [Line 6a]{.underline}: [Personnel]{.underline}: Enter total costs of
> salaries and wages of applicant/grantee staff. Do not include the
> costs of consultants; consultant costs should be included under 6h ‑
> Other. [In the Justification]{.underline}: Identify the project
> director, if known. Specify the key staff, their titles, brief summary
> of project related duties, and the percent of their time commitments
> to the project in the budget justification.
>
> [Line 6b]{.underline}: [Fringe Benefits]{.underline}: Enter the total
> costs of fringe benefits unless treated as part of an approved
> indirect cost rate. [In the Justification]{.underline}: Provide a
> break‑down of amounts and percentages that comprise fringe benefit
> costs, such as health insurance, FICA, retirement insurance, etc.
>
> [Line 6c]{.underline}: [Travel]{.underline}: Enter total costs of
> [out‑of‑town travel]{.underline} (travel requiring per diem) for staff
> of the project. Do not enter costs for consultant\'s travel - this
> should be included in line 6h. [In the Justification]{.underline}:
> Include the total number of trips, destinations, purpose, length of
> stay, subsistence allowances and transportation costs (including
> mileage rates).
>
> [Line 6d]{.underline}: [Equipment]{.underline}: Enter the total costs
> of all equipment to be acquired by the project. For all grantees,
> \"equipment\" is non‑expendable tangible personal property having a
> useful life of more than one year and an acquisition cost of \$5,000
> or more per unit. If the item does not meet the \$5,000 threshold,
> include it in your budget under Supplies, line 6e. [In the
> Justification]{.underline}: Equipment to be purchased with federal
> funds must be justified as necessary for the conduct of the project.
> The equipment must be used for project-related functions; the
> equipment, or a reasonable facsimile, must not be otherwise available
> to the applicant or its sub‑grantees. The justification also must
> contain plans for the use or disposal of the equipment after the
> project ends.
>
> [Line 6e]{.underline}: [Supplies:]{.underline} Enter the total costs
> of all tangible expendable personal property
>
> (supplies) other than those included on line 6d. [In the
> Justification:]{.underline} Provide general description of types of
> items included.
>
> [Line 6f]{.underline}: [Contractual]{.underline}: Enter the total
> costs of all contracts, including (1) procurement
>
> contracts (except those, which belong on other lines such as
> equipment, supplies, etc.). Also include any contracts with
> organizations for the provision of technical assistance. Do not
> include payments to individuals on this line. [In the
> Justification]{.underline}: Attach a list of contractors indicating
> the name of the organization, the purpose of the contract, and the
> estimated dollar amount. If the name of the contractor, scope of work,
> and estimated costs are not available or have not been negotiated,
> indicate when this information will be available. Whenever the
> applicant/grantee intends to delegate a substantial part (one-third,
> or more) of the project work to another agency, the applicant/grantee
> must provide a completed copy of Section B, SF 424A Budget Categories
> for each contractor, and separate budget justifications for each year
> of support requested.
>
> [Line 6g]{.underline}: [Construction]{.underline}: Leave blank since
> construction is not an allowable cost under this AoA program.
>
> [Line 6h]{.underline}: [Other]{.underline}: Enter the total of all
> other costs. Such costs, where applicable, may
>
> include, but are not limited to: insurance, medical and dental costs
> (i.e. for project volunteers this is different from personnel fringe
> benefits); non-contractual fees and travel paid directly to
> *individual* consultants; [local]{.underline} transportation (all
> travel which does not require per diem is considered local travel);
> postage; space and equipment rentals/lease; printing and publication;
> computer use; training and staff development costs (i.e. registration
> fees). If a cost does not clearly fit under another category, and it
> qualifies as an allowable cost, then rest assured this is where it
> belongs. [In the Justification:]{.underline} Provide a reasonable
> explanation for items in this category. For individual consultants,
> explain the nature of services provided and the relation to activities
> in the work plan. Describe the types of activities for staff
> development costs.
>
> [Line 6i]{.underline}: [Total Direct Charges]{.underline}: Show the
> totals of Lines 6a through 6h.
>
> [Line 6j]{.underline}: [Indirect Charges]{.underline}: Enter the total
> amount of indirect charges (costs), if any. If no indirect costs are
> requested, enter \"none.\" Indirect charges may be requested if: (1)
> the applicant has a current indirect cost rate agreement approved by
> the Department of Health and Human Services or another federal agency;
> or (2) the applicant is a state or local government agency.
>
> Justification: [State governments should enter the amount of indirect
> costs determined in accordance with DHHS requirements]{.underline}. An
> applicant that will charge indirect costs to the grant must enclose a
> copy of the current rate agreement. If the applicant organization is
> in the process of initially developing or renegotiating a rate, it
> should immediately upon notification that an award will be made,
> develop a tentative indirect cost rate proposal based on its most
> recently completed fiscal year in accordance with the principles set
> forth in the cognizant agency\'s guidelines for establishing indirect
> cost rates, and submit it to the cognizant agency. Applicants awaiting
> approval of their indirect cost proposals may also request indirect
> costs. It should be noted that when an indirect cost rate is
> requested, those costs included in the indirect cost pool should not
> also be charged as direct costs to the grant. Also, if the applicant
> is requesting a rate which is less than what is allowed under the
> program, the authorized representative of the applicant organization
> must submit a signed acknowledgement that the applicant is accepting a
> lower rate than allowed.
>
> [Line 6k]{.underline}: [Total]{.underline}: Enter the total amounts of
> Lines 6i and 6j.
>
> [Line 7]{.underline}: [Program Income]{.underline}: As appropriate,
> include the estimated amount of income, if any, you expect to be
> generated from this project. Program Income must be used as additional
> costs.

#####  {#section-2 .unnumbered}

##### Section C ‑ Non‑Federal Resources {#section-c-nonfederal-resources .unnumbered}

> [Line 12]{.underline}: Enter the amounts of non‑Federal resources that
> will be used in carrying out the proposed project, by source
> (Applicant; State; Other) and enter the total amount in Column (e).
> Keep in mind that if the match requirement is not met, federal dollars
> may be reduced.
>
> ***Section D ‑ Forecasted Cash Needs*** - Not applicable.
>
> ***Section E ‑ Budget Estimate of Federal Funds Needed for Balance of
> the Project***
>
> [Line 20]{.underline}: Section E is relevant for multi-year grant
> applications, where the project period is 24 months or longer. This
> section does not apply to grant awards where the project period is
> less than 17 months.

###### Section F ‑ Other Budget Information {#section-f-other-budget-information .unnumbered}

> [Line 22]{.underline}: [Indirect Charges]{.underline}: Enter the type
> of indirect rate (provisional, predetermined, final or fixed) to be in
> effect during the funding period, the base to which the rate is
> applied, and the total indirect costs. Include a copy of your current
> Indirect Cost Rate Agreement.
>
> [Line 23]{.underline}: [Remarks]{.underline}: Provide any other
> comments deemed necessary.

###### c. Standard Form 424B - Assurances {#c.-standard-form-424b---assurances .unnumbered}

> This form contains assurances required of applicants under the
> discretionary funds programs administered by the Administration on
> Aging. Please note that a duly authorized representative of the
> applicant organization must certify that the organization is in
> compliance with these assurances.

###### d. Certification Regarding Lobbying {#d.-certification-regarding-lobbying .unnumbered}

> This form contains certifications that are required of the applicant
> organization regarding lobbying. Please note that a duly authorized
> representative of the applicant organization must attest to the
> applicant's compliance with these certifications.

###### e. Other Application Components {#e.-other-application-components .unnumbered}

**Survey on Ensuring Equal Opportunity for Applicants**

> The Office of Management and Budget (OMB) has approved an HHS form to
> collect information on the number of faith-based groups applying for a
> HHS grant. Non-profit organizations, excluding private universities,
> are asked to include a completed survey with their grant application
> packet. Attached you will find the OMB approved HHS "Survey on
> Ensuring Equal Opportunity for Applicants" form (Attachment G). Your
> help in this data collection process is greatly appreciated.

**Proof of Non-Profit Status**

> Non-profit applicants must submit proof of non-profit status. Any of
> the following constitutes acceptable proof of such status:
>
> A copy of a currently valid IRS tax exemption certificate.
>
> A statement from a State taxing body, State attorney general, or other
> appropriate State official certifying that the applicant organization
> has a non-profit status and that none of the net earnings accrue to
> any private shareholders or individuals.
>
> A certified copy of the organization's certificate of incorporation or
> similar document that clearly establishes non-profit status.

## Indirect Cost Agreement

> Applicants that have included indirect costs in their budgets must
> include a copy of the current indirect cost rate agreement approved by
> the Department of Health and Human Services or another federal agency.
> This is optional for applicants that have not included indirect costs
> in their budgets.

**Attachment B: Budget Narrative, Page 1 -- Sample Format with
EXAMPLES**

+---------+------+-----+-----+-----------+----------------------------+
| > *     | *    | **N | **N | # TOTAL   | ### Justification {#       |
| *Object | *Fed | on- | on- |           | justification .unnumbered} |
| > Class | eral | Fed | Fed |           |                            |
| > Cat   | Fun  | era | era |           |                            |
| egory** | ds** | l** | l** |           |                            |
|         |      |     |     |           |                            |
|         |      | **  | **  |           |                            |
|         |      | Cas | In- |           |                            |
|         |      | h** | Kin |           |                            |
|         |      |     | d** |           |                            |
+---------+------+-----+-----+-----------+----------------------------+
| **Pers  | \$40 |     | \   | \$45,000  | Project Supervisor (name)  |
| onnel** | ,000 |     | $5, |           | = .3FTE @ \$50,000/yr =    |
|         |      |     | 000 |           | \$15,000                   |
|         |      |     |     |           |                            |
|         |      |     |     |           | Project Director (name) =  |
|         |      |     |     |           | 1FTE @ \$30,000 = \$30,000 |
+---------+------+-----+-----+-----------+----------------------------+
| *       | \$12 | 0   | 0   | \$12,600  | Fringes on Supervisor and  |
| *Fringe | ,600 |     |     |           | Director @ 28% of salary.  |
| Ben     |      |     |     |           |                            |
| efits** |      |     |     |           | FICA (7.65%) = \$3,442     |
|         |      |     |     |           |                            |
|         |      |     |     |           | Health (12%) = \$5,400     |
|         |      |     |     |           |                            |
|         |      |     |     |           | Dental (5%) = \$2,250      |
|         |      |     |     |           |                            |
|         |      |     |     |           | Life (2%) = \$ 900         |
|         |      |     |     |           |                            |
|         |      |     |     |           | Workers Comp Insurance     |
|         |      |     |     |           | (.75%) = \$ 338            |
|         |      |     |     |           |                            |
|         |      |     |     |           | Unemployment Insurance     |
|         |      |     |     |           | (.6%) = \$ 270             |
+---------+------+-----+-----+-----------+----------------------------+
| **T     | \$3  | 0   | \$  | \$3,967   | Travel to Annual Grantee   |
| ravel** | ,000 |     | 967 |           | Meeting:                   |
|         |      |     |     |           |                            |
|         |      |     |     |           | Airfare: 1 RT x 2 people x |
|         |      |     |     |           | \$750/RT = \$1,500         |
|         |      |     |     |           |                            |
|         |      |     |     |           | Lodging: 3 nights x 2      |
|         |      |     |     |           | people x \$100/night = \$  |
|         |      |     |     |           | 600                        |
|         |      |     |     |           |                            |
|         |      |     |     |           | Per Diem: 4 days x 2       |
|         |      |     |     |           | people x \$40/day = \$ 320 |
|         |      |     |     |           |                            |
|         |      |     |     |           | Out-of-Town Project Site   |
|         |      |     |     |           | Visits                     |
|         |      |     |     |           |                            |
|         |      |     |     |           | Car mileage: 3 trips x 2   |
|         |      |     |     |           | people x 350 miles/trip    |
|         |      |     |     |           |                            |
|         |      |     |     |           | x \$ .365/mile = \$ 767    |
|         |      |     |     |           |                            |
|         |      |     |     |           | Lodging: 3 trips x 2       |
|         |      |     |     |           | people x 1 night/ trip     |
|         |      |     |     |           |                            |
|         |      |     |     |           | x \$50/night = \$300       |
|         |      |     |     |           |                            |
|         |      |     |     |           | Per Diem: 3 trips x 2      |
|         |      |     |     |           | people x 2days/trip        |
|         |      |     |     |           |                            |
|         |      |     |     |           | x \$40/day = \$480         |
+---------+------+-----+-----+-----------+----------------------------+

Attachment B: Budget Narrative, Page 2 - Sample Format with EXAMPLES

+-------+---------+-----+----+------+-------------------------------+
| **O   | **Fe    | ##  | *  | #    | ### Justification {           |
| bject | deral** | ### | *N | ###  | #justification-1 .unnumbered} |
| Cl    |         |  No | on | *[TO |                               |
| ass** | # Funds | n-F | -F | TAL] |                               |
|       |         | ede | ed | {.un |                               |
| **    |         | ral | er | derl |                               |
| Categ |         |  {# | al | ine} |                               |
| ory** |         | non | I  | * {# |                               |
|       |         | -fe | n- | tota |                               |
|       |         | der | Ki | l-1  |                               |
|       |         | al  | nd | .unn |                               |
|       |         | .un | ** | umbe |                               |
|       |         | num |    | red} |                               |
|       |         | ber |    |      |                               |
|       |         | ed} |    |      |                               |
|       |         |     |    |      |                               |
|       |         | ### |    |      |                               |
|       |         | ##  |    |      |                               |
|       |         | Cas |    |      |                               |
|       |         | h { |    |      |                               |
|       |         | #ca |    |      |                               |
|       |         | sh  |    |      |                               |
|       |         | .un |    |      |                               |
|       |         | num |    |      |                               |
|       |         | ber |    |      |                               |
|       |         | ed} |    |      |                               |
+-------+---------+-----+----+------+-------------------------------+
| **E   | 0       | 0   | 0  | 0    | No equipment requested        |
| quipm |         |     |    |      |                               |
| ent** |         |     |    |      |                               |
+-------+---------+-----+----+------+-------------------------------+
| **    | \$1,500 |     | \  | \$3  | Laptop computer for use in    |
| Suppl |         |     | $2 | ,500 | client intakes = \$1,340      |
| ies** |         |     | ,0 |      |                               |
|       |         |     | 00 |      | Consumable supplies (paper,   |
|       |         |     |    |      | pens, etc.)                   |
|       |         |     |    |      |                               |
|       |         |     |    |      | \$100/mo x 12 months =        |
|       |         |     |    |      | \$1,200                       |
|       |         |     |    |      |                               |
|       |         |     |    |      | Copying \$80/mo x 12 months = |
|       |         |     |    |      | \$ 960                        |
+-------+---------+-----+----+------+-------------------------------+
| **Con | \$      | \$  | 0  | \    | Contracts to A,B,C direct     |
| tract | 200,000 | 50, |    | $250 | service providers (name       |
| ual** |         | 000 |    | ,000 | providers)                    |
|       |         |     |    |      |                               |
|       |         |     |    |      | adult day care contractor =   |
|       |         |     |    |      | \$75,000                      |
|       |         |     |    |      |                               |
|       |         |     |    |      | respite care contractor in    |
|       |         |     |    |      | home= \$75,000                |
|       |         |     |    |      |                               |
|       |         |     |    |      | respite care contractor-NF =  |
|       |         |     |    |      | \$50,000                      |
|       |         |     |    |      |                               |
|       |         |     |    |      | personal care/companion       |
|       |         |     |    |      | provider = \$50,000           |
|       |         |     |    |      |                               |
|       |         |     |    |      | See detailed budget           |
|       |         |     |    |      | justification for each        |
|       |         |     |    |      | provider (and then provide    |
|       |         |     |    |      | it!)                          |
+-------+---------+-----+----+------+-------------------------------+

+------+------+-----+-----+------+----------------------------------+
| At   |      |     |     |      |                                  |
| tach |      |     |     |      |                                  |
| ment |      |     |     |      |                                  |
| B:   |      |     |     |      |                                  |
| Bu   |      |     |     |      |                                  |
| dget |      |     |     |      |                                  |
| Na   |      |     |     |      |                                  |
| rrat |      |     |     |      |                                  |
| ive, |      |     |     |      |                                  |
| Page |      |     |     |      |                                  |
| 3 -- |      |     |     |      |                                  |
| Sa   |      |     |     |      |                                  |
| mple |      |     |     |      |                                  |
| Fo   |      |     |     |      |                                  |
| rmat |      |     |     |      |                                  |
| with |      |     |     |      |                                  |
| EXAM |      |     |     |      |                                  |
| PLES |      |     |     |      |                                  |
+------+------+-----+-----+------+----------------------------------+
| *    | \$10 | \   | \$  | \$37 | Local conference registration    |
| *Oth | ,000 | $8, | 19, | ,800 | fee (name conference) = \$ 200   |
| er** |      | 000 | 800 |      |                                  |
|      |      |     |     |      | Printing brochures (50,000 @ \$  |
|      |      |     |     |      | .05 ea) = \$ 2,500               |
|      |      |     |     |      |                                  |
|      |      |     |     |      | Video production = \$19,800      |
|      |      |     |     |      |                                  |
|      |      |     |     |      | Video Reproduction = \$ 3,500    |
|      |      |     |     |      |                                  |
|      |      |     |     |      | NF Respite Training Manual       |
|      |      |     |     |      | reproduction                     |
|      |      |     |     |      |                                  |
|      |      |     |     |      | \$3/manual x \$2000 manuals = \$ |
|      |      |     |     |      | 6,000                            |
|      |      |     |     |      |                                  |
|      |      |     |     |      | Postage \$150/mo x 12 months =   |
|      |      |     |     |      | \$ 1,800                         |
|      |      |     |     |      |                                  |
|      |      |     |     |      | Caregiver Forum meeting room     |
|      |      |     |     |      | rentals                          |
|      |      |     |     |      |                                  |
|      |      |     |     |      | \$200/day x 12 forums = \$ 2,400 |
|      |      |     |     |      |                                  |
|      |      |     |     |      | Respite Training Scholarships =  |
|      |      |     |     |      | \$1,600                          |
+------+------+-----+-----+------+----------------------------------+
| **   | 0    | 0   | 0   | 0    | None                             |
| Indi |      |     |     |      |                                  |
| rect |      |     |     |      |                                  |
| C    |      |     |     |      |                                  |
| harg |      |     |     |      |                                  |
| es** |      |     |     |      |                                  |
+------+------+-----+-----+------+----------------------------------+
| ##   | \    | \$  | \$  | \    |                                  |
| ###  | $267 | 58, | 27, | $352 |                                  |
| TOTA | ,100 | 000 | 767 | ,267 |                                  |
| L {# |      |     |     |      |                                  |
| tota |      |     |     |      |                                  |
| l-2  |      |     |     |      |                                  |
| .unn |      |     |     |      |                                  |
| umbe |      |     |     |      |                                  |
| red} |      |     |     |      |                                  |
+------+------+-----+-----+------+----------------------------------+

Attachment C: Budget Narrative -- Page 1 -- Sample Format

+-------+----+----+----+-----------+--------------------------------+
| > **O | *  | *  | *  | # TOTAL   | ### Justification              |
| bject | *F | *N | *N |           | {#justification-2 .unnumbered} |
| >     | ed | on | on |           |                                |
| Class | er | -F | -F |           |                                |
| >     | al | ed | ed |           |                                |
| Categ | F  | er | er |           |                                |
| ory** | un | al | al |           |                                |
|       | ds | ** | ** |           |                                |
|       | ** |    |    |           |                                |
|       |    | ** | *  |           |                                |
|       |    | Ca | *I |           |                                |
|       |    | sh | n- |           |                                |
|       |    | ** | Ki |           |                                |
|       |    |    | nd |           |                                |
|       |    |    | ** |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **P   |    |    |    |           |                                |
| erson |    |    |    |           |                                |
| nel** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **F   |    |    |    |           |                                |
| ringe |    |    |    |           |                                |
| Benef |    |    |    |           |                                |
| its** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **Tra |    |    |    |           |                                |
| vel** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **E   |    |    |    |           |                                |
| quipm |    |    |    |           |                                |
| ent** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+

**Attachment C: Budget Narrative -- Page 2 -- Sample Format**

+-------+----+----+----+-----------+--------------------------------+
| > **O | *  | *  | *  | # TOTAL   | ### Justification              |
| bject | *F | *N | *N |           | {#justification-3 .unnumbered} |
| >     | ed | on | on |           |                                |
| Class | er | -F | -F |           |                                |
| >     | al | ed | ed |           |                                |
| Categ | F  | er | er |           |                                |
| ory** | un | al | al |           |                                |
|       | ds | ** | ** |           |                                |
|       | ** |    |    |           |                                |
|       |    | ** | *  |           |                                |
|       |    | Ca | *I |           |                                |
|       |    | sh | n- |           |                                |
|       |    | ** | Ki |           |                                |
|       |    |    | nd |           |                                |
|       |    |    | ** |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **    |    |    |    |           |                                |
| Suppl |    |    |    |           |                                |
| ies** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **Con |    |    |    |           |                                |
| tract |    |    |    |           |                                |
| ual** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **Ot  |    |    |    |           |                                |
| her** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| **Ind |    |    |    |           |                                |
| irect |    |    |    |           |                                |
| Char  |    |    |    |           |                                |
| ges** |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+
| ####  |    |    |    |           |                                |
| # TOT |    |    |    |           |                                |
| AL {# |    |    |    |           |                                |
| total |    |    |    |           |                                |
| -5 .u |    |    |    |           |                                |
| nnumb |    |    |    |           |                                |
| ered} |    |    |    |           |                                |
+-------+----+----+----+-----------+--------------------------------+

Attachment D: Project Work Plan, Page 1 -- Sample Format

  --------------- ---------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Goal:**                                                                                                                                               

  **Measurable                                                                                                                                            
  Outcome(s):**                                                                                                                                           

  **Major         **Key Tasks**                **Lead     **Timeframe                                                                                     
  Objectives**                                 Person**   (Start and                                                                                      
                                                          End Date by                                                                                     
                                                          Month)**                                                                                        

                                                          **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  1\.                                                                                                                                                     

                                                                                                                                                          

                                                                                                                                                          

                                                                                                                                                          

  2\.                                                                                                                                                     

                                                                                                                                                          

                                                                                                                                                          

                                                                                                                                                          
  --------------- ---------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------

Attachment D: Project Work Plan, Page 2 -- Sample Format

  -------------- ---------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**                **Lead     **Timeframe                                                                                     
  Objectives**                                Person**   (Start and                                                                                      
                                                         End Date by                                                                                     
                                                         Month)**                                                                                        

                                                         **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  3\.                                                                                                                                                    

                                                                                                                                                         

                                                                                                                                                         

                                                                                                                                                         

  4\.                                                                                                                                                    

                                                                                                                                                         

                                                                                                                                                         

                                                                                                                                                         
  -------------- ---------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------

Attachment D: Project Work Plan, Page 3 -- Sample Format

  -------------- ---------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**                **Lead     **Timeframe                                                                                     
  Objectives**                                Person**   (Start and                                                                                      
                                                         End Date by                                                                                     
                                                         Month)**                                                                                        

                                                         **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  5\.                                                                                                                                                    

                                                                                                                                                         

                                                                                                                                                         

                                                                                                                                                         

  6\.                                                                                                                                                    

                                                                                                                                                         

                                                                                                                                                         

                                                                                                                                                         
  -------------- ---------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------

NOTE: Please do note infer from this sample format that your work plan
must have 6 major objectives. If you need more pages, simply repeat this
format on additional pages.

Attachment E

Instructions for Completing the Project Summary/Abstract

-   All applications for grant funding must include a Summary/Abstract
    that concisely describes the proposed project. It should be written
    for the general public.

```{=html}
<!-- -->
```
-   To ensure uniformity, please limit the length to no more than 265
    words on a single page with a font size of not less than 11,
    doubled-spaced.

-   The abstract must include the project's goal(s), objectives, overall
    approach (including target population and significant partnerships),
    anticipated outcomes, products, and duration. The following are very
    simple descriptions of these terms, and a sample Compendium
    abstract.

> **Goal(s)** -- broad, overall purpose, usually in a mission statement,
> i.e. what you want to do, where you want to be
>
> **Objective(s)** -- narrow, more specific, identifiable or measurable
> steps toward a goal. Part of the planning process or sequence (the
> "how"). Specific performances which will result in the attainment of a
> goal.
>
> **Outcomes -** measurable results of a project. Positive benefits or
> negative changes, or measurable characteristics that occur as a result
> of an organization's or program's activities. (outcomes are the
> end-point)

**Products --** materials, deliverables.

-   A model abstract/summary is provided below:

The grantee, Okoboji University, supports this three year Dementia
Disease demonstration (DD) project in collaboration with the local
Alzheimer's Association

and related Dementias groups. The [goal]{.underline} of the project is
to provide comprehensive, coordinated care to individuals with memory
concerns and to their caregivers. The approach is to expand the services
and to integrate the bio-psycho-social aspects of care. The
[objectives]{.underline} are: 1) to provide dementia specific care,
i.e., care management fully integrated into the services provided; 2) to
train staff, students and volunteers; 3) to establish a system
infrastructure to support services to individuals with early stage
dementia and to their caregivers; 4) to develop linkages with community
agencies; 5) to expand the assessment and intervention services; 6) to
evaluate the impact of the added services; 7) to disseminate project
information. The expected [outcomes]{.underline} of this DD project are:
patients will maintain as high a level of mental function and physical
functions (thru Yoga) as possible; caregivers will increase ability to
cope with changes; and pre and post -- project patient evaluation will
reflect positive results from expanded and integrated services. The
[products]{.underline} from this project are: a final report, including
evaluation results; a website; articles for publication; data on driver
assessment and in-home cognitive retraining; abstracts for national
conferences.

**Attachment F**

**Survey Instructions on Ensuring Equal Opportunity for Applicants**

**Applicant Organization's Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Applicant's DUNS Number:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Grant Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_CFDA
Number: \_\_\_\_\_\_\_\_\_\_\_\_\_**

1\. Does the applicant have 501(c)(3) status?

Yes No

2\. How many full-time equivalent employees does the applicant have?
*(Check only one box).*

> 3 or Fewer 15-50
>
> 4-5 51-100
>
> 6-14 over 100

3\. What is the size of the applicant's annual budget? *(Check only one
box.)*

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

\$1,000,000 - \$4,999,999

\$5,000,000 or more

4\. Is the applicant a faith-based/religious\
organization?

Yes No

5\. Is the applicant a non-religious community-based organization?

Yes No

6\. Is the applicant an intermediary that will manage the grant on
behalf of other organizations?

> Yes No

7\. Has the applicant ever received a government grant or contract
(Federal, State, or local )?

Yes No

8\. Is the applicant a local affiliate of a national\
organization?

Yes No

**Provide the applicant's (organization) name and DUNS number and the
grant name and CFDA number.**

1\. 501(c)(3) status is a legal designation provided on application to
the Internal Revenue Service by eligible organizations. Some grant
programs may require nonprofit applicants to have 501(c)(3) status.
Other grant programs do not.

2\. For example, two part-time employees who each work half-time equal
one full-time equivalent employee. If the applicant is a local affiliate
of a national organization, the responses to survey questions 2 and 3
should reflect the staff and budget size of the local affiliate.

3\. Annual budget means the amount of money your organization spends
each year on all of its activities.

4\. Self-identify.

5\. An organization is considered a community-based organization if its
headquarters/service location shares the same zip code as the clients
you serve.

6\. An "intermediary" is an organization that enables a group of small
organizations to receive and manage government funds by administering
the grant on their behalf.

7.  Self-explanatory.

8.  Self-explanatory.

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1890-0014. The time required
to complete this information collection is estimated to average five (5)
minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review
the information collection. **If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form,
please write to:** U.S. Department of Education, Washington, D.C.
2202-4651.

**If you have comments or concerns regarding the status of your
individual submission of this form, write directly to:** Joyce I. Mays,
Application Control Center, U.S. Department of Education, 7^th^ and D
Streets, SW, ROB-3, Room 3671, Washington, D.C. 20202-4725

> OMB No. 1890-0014 Exp. 1/31/20