### SOCIAL	INNOV **AT ION	FUND	(SIF)**  **PA**

**Y	FOR	SUCCESS	PILOT PROGRAM**  **FUNDING AV** 

**AILABILITY APPLICA**  **TION	INSTR UCTIONS**  **OMB Contr ol #:**  **TBD Expiration Date:**  **12/31/201 5** 2



## IMPORTANT	NOTICE These	application	instructions	conform	to	the	Corporation	for	National	and	Community	Service’s	online	grant application	system, eGrants .	All	funding	announcements	by	the	Corporation	for	National	and	Community Service	(CNCS)	are	posted	on www .nationalservice.gov and www .grants.gov . **Public	Burden	Statem ent:**  Public	reporting	burden	for	this	collection	of	information	is	estimated	to	average 30 hours	per	submission,	including	reviewing	instructions,	gathering	and	maintaining	the	data	needed,	and completing	the	form.	Comments	on	the	burden	or	content	of	this instrument	may	be	sent	to	the	Corporation for	National	and	Community	Service,	Attn:	Am y	Borgstrom,	1201	New	Y ork	A ve nue,	NW

,	W ashington,	D.C. 20525.	CNCS	informs	people	who	may	respond	to	this	collection	of	information	that	they	are	not	required	to respon d	to	the	collection	of	information	unless	the	OMB	control	number	and	expiration	date	displayed	on page	one	are	current	and	valid.	(See	5	C.F .R.	§	1320.5(b)(2)(i).) **Privacy	Act	Notice:** The	Privacy	Act	of	1974	(5	U.S.C	§	552a)	requires	that	the	following	n otice	be	provided	to you:	The	information	requested	on	the	Social	Innovation	Fund	P ay for	Success	Application	Instructions	is collected	pursuant	to	42	U.S.C.	§§	12 6 53k of	the	National	and	Community	Service	Act	of	1990	as	amended, and	42	U.S.C.	12639 .	Purpo ses	and	Uses
- The	information	requested	is	collected	for	the	purposes	of	reviewing grant	applications	and	granting	funding	requests.	Routine	Uses
- Routine	uses	may	include	disclosure	of	the information	to	federal,	state,	or	local	agencies	pursuant	to	law fully	authorized	requests.	In	some	programs, the	information	may	also	be	provided	to	federal,	state,	and	local	law	enforcement	agencies	to	determine	the existence	of	an y	prior	criminal	con victions.	Executive	Summaries	of	all	compliant	applications	recei ved and applications	of	successful	applicants	will	be	published	on	the	CNCS	website	as	part	of	ongoing	efforts	to increase	transparency	in	grantmaking.	This	is	described	in	more	detail	in	the Notice	of	Federal	Funding Av ailabilit

y/Opportunity

. Effects	of	Nond isclosure
- The	information	requested	is	mandatory	in	order	to receive funding
. **Fe deral	Funding	Accountability	and	T**  **ransparency	Act:** Grant	recipients	will	be	required	to	report	at www .FSRS. gov on	all	subawards	over	$25,000	and	may	be	required	to	report	on	ex ecuti ve compensation	for recipients	and	subrecipients.	Recipients	must	have	the	necessary	systems	in	place	to	collect	and	report	this information. See	2	C.F

.R.	P art	170	for	more	informati on	and	to	determine	how	these	requirements	apply
. **Universal	Identifier:** Applications	must	include	a	Dun	and	Bradstreet	Data	Universal	Numbering	S ystem (DUNS)	number	and	register	with	the	Central	Contractor’s	Registry	(CCR). All	grant	recipients	are required	to maintain	a	valid	registration,	which	must	be	renewed	annually
.3 

## APPLICA **TION	RESOUR CES**  Use	these	instructions	in	conjunction	with	the Social	Innov ation	Fund Pay	for	Success Gr ants	Competition	(PFS	Competition) Notice	of Fu nding Av ailability ( Notice )
. **The Notice**  **includes	deadlines,	eligibility	requirements,	submission	requirements,	funding priorities	and	other	rele**  **va nt	information	that	might	change	annuall**  **y.** Other	resources	for	completing	y our	application	includ ing technical	assistance	confere nce calls	and how	to submit	inquiries can	be	accessed	from	the Social	Innov ation	Fund	( SIF ) webpage	on	the	CNCS	website ( http://www .nationalservice.gov/progr ams/social
innov ation
- fund )
. 

## CREA **TING	AN	EGRANTS	USER OR	OR**  **GANIZA TION**  **ACCOUNT** First
- time	eGrants users need	to create an	eGrants	account	by	accessing	this	link: https://egrants.cns.gov/espan/main/login.jsp and	selecting **Don’t	have	an	eGrants account?	Create	an	account.**  If	y ou	need	help	establishing	a	new	organization	account	or	a	new	user	account	for	an existing	organization	account, or	with	other	aspects	of	eGr ants, contact	the	National	Service Hotline	at	800
- 942
- 2677 or	via: https://questions.nationalservice.gov/app/ask
. **If	y ou	are	appl**  **ying for	continuation	funding	(**  **for	y ears	2	and	be**  **yo nd**  **)	of	an	e xisting**  **SIF PFS**  **gr ant,	please	skip	to	the	‘REQUESTING	CONTINU**  **AT ION	FUNDING’	Section**  **of this	document**  **.** 

## NEW	APPLICA **TIONS** To	initiate	an	application :  Start	a	n ew g rant a pplication:	Select **New** under	the **Creating	an	Application** heading on	your	Home	Page  Select	a	Program	Area : **Other**
 Select	a NOFA : Social	Innovation	Fund	Pay	for	Success Grants	Competition [ Applicable year	of	funding] Once	y ou	have	initiated	an	application,	it	will	be	listed	in	the **View	My	Grants/Applications** section	of yo ur homepage.		If	y ou	exit	and	then	return	to	eGr ants	and	wish	to	continue entering	or	editing	y our	application,	please	open	y our	saved	version	by	selecting **View	My Grants/Applications** 
. Yo u	should	not use	the **New** button	again	as	this	will	start	a	br and new	a pplication. 

## APPLICA **TION	C ONTENT**  Your	application	consists	of	the	following section s . Please complete	each	section. I. Applicant	Info4



### II. Application	Info III. Narratives IV. Performance	Measures

– if	required	in	the Notice V. Documents VI. Budget VII. Review,	Authorize,	and Submit Information	entered	in	the	Applicant	Info ,	Application	Info,	and	Budget	sections	will populate	the	SF	424	Face sheet of	your	application
. 

### I. **Applicant	Info**

 Under **Project	Information** select **Enter	New** , create a	title	for	the	proposed	project, and enter the	contact	information
.  **Select	a	Project	Initiative** :		Choose	the	oper ational	model	which	best	describes	y our PFS	Competition application .		Please	see	the Notice for	details.  S elect	an	individual	as	the **Project	Director** , by choos ing a	name	from	the pull
- down menu	or	add ing a	new	contact. Please	note	that	the **Au thorized	R**  **epresentative** will	be	filled	in	at	the	end	of	the application	when	completing the	Assur ances and	Certifications section .	(Attachment	A) 

### II. **Application	Info Complete	this	section	as**  **follows:**  **Areas	affected	by	the	project** :		List	onl y	the	largest	political	or	municipal	entities affected	(e.g.,	counties	and	cities). Please	include	the	two
- letter	abbreviation	with	both letters	capitalized	for	each	state	where	y ou	plan	to	oper ate.	Separ ate	each	two
- letter state	abbr eviation	with	a	comma.	F or	city	or	county	information,	please	follow	each	one with	the	two
- letter	capita lized	state	abbreviation.  **Proposed	project	start	and	end	dates**
. Please	see	the Notice for	details about	the project	period	to	select
.  **Intergovernmental	Review	of	F ederal	Programs:**  Enter ‘No.’ This program	is	NOT subject	to	Ex ecutiv e	Or der	12372.  **Delinque nt	on	any	federal	debt:**  Check	the	appropriate	box.		This	question	applies	to the	applicant	organization,	not	the	person	who	signs	as	the	authorized	representativ e. Categories	of	debt	include	delinquent	audit	allow ances,	loans,	and	tax es.		If ‘Ye s ’ ,	type yo ur	explanation	in	the	text	box	provided.  **Sta te	Application	Identifier**  :		Enter	N/A. **Note:** Fa lsification	or	concealment	of	a	material	fact	or	submission	of	false,	fictitious , or fr audulent	statements	or	representations	to	any	department	or	agency	of	the	United	States Government	may	result	in	a	fine	or	imprisonment	for	not	more	than	fiv e	(5)	y ears,	or	both. (18	USC	§	1001).5 

### III. **Narrativ es**  The application	narr ative	has five sections:  Ex ecutiv e	Summary  Program	Design  Organizational	Capacity  Leadership	and	T

eam  Cost	Effectiv eness	and	Budget	Adequacy **Pa ge	Limit**  **and	F ormatting**   It	is	important	that	y ou	preview	the	eGr ants PDF of	y our	application	to	ensure	that	y ou don ’t	ex ceed	the	page	limit as	prescribed	in	the Notice .		R eviewers	will stop	reading yo ur	application	when	they	reach	the	page	limit.  Also,	p lease	note	that	bold	face,	bullets,	underlines, charts,	diagr ams,	and	tabl es or	other types	of formatting will	not	copy	into	eGr ants.
**A. Ex**  **ecuti ve**  **Summary** The	e xe cutive	summar y will	be	used	in	the	initial	eligibility	review	to	assess	an applicant’s	status	as	an	existing	gr antmaking	institution	or	an	eligible	partnership,	and to	confirm	its	identification	as	either	a	geogr aphicall y - based	or	issue
- based	Social Innov ation	Fund (see the	eligibility	section	of	the Notice ). Therefore,	the	summary should	contain	clear	and	concise	indications	of	both	eligibility	criteria. Please	note	that	ex ecuti ve summaries	for	all	applications	will	be	made	public	and posted	to	CNCS’ s website. Please	complete the	Executive	S ummary as	follows: Heading : Fo r	the	title	of	the	Ex ecutiv e	Summary ,	applicants	should	use	the	name	of	the sole	or	lead R ecipient (if	an	eligible	partnership). P rovide	a	summary	of	the	proposed	progr am as	follows : Ov erview :  Describe	the	applicant	organization including	whether it	is	an	existing grantmaking	institution	or an eligible	partnership
.  Identify	as	either	a	geogr aphicall y - based	or an issue
- based	Social	Innovation Fund
.  Identify	priority	issue	area(s)	of	focus
.  Id entify	geogr aphic	areas	where Subrecipient s	or	Service	R ecipients ar e	lik el y	to be	located
.  Identify	other	organizations	that	will	play	a	k ey	role	in	the	implementation	of	the str ategy	to	select,	support,	monitor ,	or	ev aluate Subrecipient s	or	Service6 

### Re cip ients

. 

### If	appl ying	as	an	eligible	partnership, **clearl y	identify**  the	other members	of	the	partnership.  Identify	the	gr ant	amount	being	requesting	and	the	proposed	gr ant	period
.  Identify	the	main	sources	of	match	that have	been secured
. Project	Summary:  Provide	an	ov erview	of	the	proposed	progr am	and	the	need(s)	the	progr am	will meet ,	as	related	to	the	Progr ammatic	Approach	outlined	in	the Notice.  Outline	the	progr am ’s	theory	of	change	and	d escribe	the	measur able	outcomes the program	w ill achieve	in	the	i dentified	issue	area(s)
.  Provide	an	ov erview	of	the	proposed Subrecipient or	Service	R ecipient portfolio str ategy	including	selection,	ev aluation,	and	growth	of Subrecipient or Service R ecipients
.  Briefl y	describe	the	experience,	expertise,	and	other	stren gths	or	assets	the organization and	its	partners will	contribute	to	successfull y	realizing its identified	outcomes. **Applicants should complete the narrative sections of Program Design, Organizational Capability, Leadership and Team,**  **and Cost Effectiveness and Budget Adequacy by responding to the selection criteria detailed in the Notice.**  

### B. **Program	Design** In r esponding	to	the	pr ogr am	design	criteria,	applicants	should	demonstr ate	the identification	of	a	compelling	need(s)	and	desired outcomes,	and	describe	a	convincing str ategy	for	achieving	those	outcomes	through	the	selection,	support,	ev aluation	and scaling	of	evidence
- based	progr am	interv entions. Applicants	should	describe	the	structure	and	composition	of	the	progr am,	including a preliminary	work	plan	to	achiev e	each	of	the	activities	specified	in	the	progr am. Applicants	should	describe	in	detail	how	each	component	of	the	progr am	will	further both	the	ov er all	Theory	of	Change	addressed	in	the Notice ,	as	well	as	the	ability	of Su brecipient s	or	Service	R ecipients	to	achiev e	their	progr ammatic	goals. Describe	i f	the	proposed	progr am	will	address	SIF PFS funding	priorities	identified	in the Notice
. **C. Organizational	Capa**  **bilit y**  In	responding	to	the	organizational capability criteria,	applicants	should	demonstrate the	experience	and	capacity	to	successfully	implement	the	proposed	grant	program	and to	adhere	to	the	requirements	and	expectations	of	a	SIF PFS	R ecipient
. Applicants should	describe	their	track	record	and	experien ce	of	grantmaking,	including	selecting and	working	with Subrecipient s	or	Service	Recipients.7



### If	y ou	are	requesting	a	reduced	match	requirement, provide	the	information	requested in	the Notice
. **D. Leadership	and	Team**  In	responding	to	the	leadership	team	criteria,	applicants	should	demonstrate	the personnel	responsible	for	successfully	delivering	the	proposed	grant	program, including	relevant	experience	of	each	of	the	team	members
. If	the	applicant	is proposing	to	broa den	their	team,	include	a	hiring	and	staffing	plan	as	part	of	this response. **E. Cost	Effecti** **ve ness	and	Budget	Adequacy**  In	completing	the	budget	and	responding	to	these	criteria,	y ou	should	demonstr ate	a reasonable	plan	for	meeting	the	financial	needs	of	the	proposed	progr am	and	for	r aising the	required match. In	this	section,	applicants	should	also	describe	how	they	will ensure the	in
- kind	or	cash	match	of	their Subrecipient s	or	Service	R ecipients. **The	following	three	sections are	not	relevant	to**  **this	application.	Please	enter	N/A	for not	applicable	under	these	narrative	sections.**  **F. Amendment	Justification**  Enter	N/A.	Th is	field is	used	when	requesting	an	amendment	to	an	awarded	grant
. **G. Clarification	Information**  Enter	N/A.	This	field is used	to	enter	information	that	requires	clarification	in	the	post
review	period. **H. Continuation	Changes**  Enter	N/A.	This	field is used	to	enter information	for yo ur	continuation	requests. 

### IV. **Pe rformance	Measur**  **es If**  **Performance Measures**  **are required**  **in the**  **Notice ,**  **follow the**  **instructions in**  **Attachment	B .**  

### V. **Documents** In	addition	to	the	application	submitted	in	eGr ants,	y ou	are	required	to	provide documentation	of	match	as	described	in the **Submitting	Match	V erification**  section	of	the Notice
. After yo u	have	submitted all	required	documentation ,	change	the	status	in eGr ants from	the	default	“Not	Sent”	to	the	applicable	status	“Sent
. ”8 

### VI. **Budget A.**  **Budget	R equirements**  Applicants	must	submit	a	proposed	budget for	each	of	the three ye ars	of	the	project period that	includes	both	feder al	and	match	funding.		If	an	application is	selected	for award,	CNCS	will	determine	the	final	amount	of	the	aw ard	of	feder al	funds,	and	will negotiate	a	final	budget.		Upon	aw ard,	compliance	with	the	approv ed	budget	will	be	a material	term	and	condition	of	the	cooper ative	agreement	with	the R ecip ient
. Yo ur	proposed	budget	should	be	sufficient	to	allow	y ou	to	perform	the	tasks	described in	y our	narr ative fo r	each	y ear	of	the	project and provide	a	full	explanation	of	costs including	their	purpose,	justification,	and	the	basis	of	y our	calculations. Reviewers	will consider	the	information	y ou	provide	in yo ur	budget as	part	of their	assessment	of	the Cost Effectiv eness	and	Budget	Adequacy c riteria
. In	eGr ants,	the	prepar ation	of	a	detailed	budget	provides	the	data	that	creates	the summary	budget	and	the	budget	narr ative.		The d etailed	budget	should	provide	a	full explanation	of	associated	costs	including	their	purpose,	justification,	and the	basis	of the	calculations. eGr ants	will	perform	a	limited	compliance	check	to	v alidate	the	budget. If	it	finds	any	compliance	issues	y ou	will	receiv e	a	w arning	and/or	error	messages.	Y ou must	resolv e	all	errors	before	y ou	can	submit	y our	budget. As	yo u	prepare	your	budget:  Divide	project	costs	by	year	and	submit	one	for	each	year	of	the proposed project period. Add	future	budget	years	by	clicking	“Add Subsidiary	Budget” or	“Copy Subsidiary	Budget”.		Type	“Budget	Year	2”	or	“Budget	Year	3”	in	“Enter Sub	Budget Description” text	box.  

### All	the	amounts	you	request	must	be	for	a	particular	purpose.	Do	not	include miscellaneous,	contingency,	or	other	undefined	budget	amounts. For	recipients providing	subawards	to	subrecipients, a minimum	of	80%	of	federal	d ollars	granted must	be	provided	to	subrecipients	or	spent	on	service	recipients.  Itemize	each	cost	and	present	the	basis	for	all	calculations	in	the	form	of	an equation ,	identifying	the	number	of	persons	inv ol ve d	with	the	ev ent,	the	cost	per person	or	un it,	or	the	annual	salary	cost.  Do	not	include	fractional	amounts	(cents).  PFS	Competition recipients are	required to match	feder al	dollars awarded on	a	one to - one	basis
. Subrecipients	and	Service	R ecipients	will	also	be	required	to	match money	receiv ed	o n	a	one - to - one	bas i s. U p	to	50%	of	the	match can	be provided	by in
- kind contributions .	Otherwise, the	match	must	be provided	by	nonfeder al	dollars.  Because	of	the	required	one
- to - one	match	for	Social	Innov ation	Fund Pay	for	Success recipient s,	the	budget must	reflect **total** costs	being	distributed	equall y	between	the feder al	and re cipient shares,	but	individual	categories **do	not** have	to	be	equally distributed.9



### Programs	must	comply	with	all	applicable	feder al	laws,	regulations,	and	OMB requirements for	gran t	management under Title	2	of	the	Code	of	F ederal	R egulations	(2 CFR	Part	200	and	CNCS’s	implementing regulations	at	2	CFR	Part	2205 ) ,	including providing	audits	to	the Fe der al	Audit	Clearinghouse if	expending	ov er	$ 750 ,000	in feder al	funds,	as requir ed in 2	C.F .R.	§	200.501. Allowable	Costs Please	refer	to	the Unif

orm	Cost	Principles	(2	CFR	Subpart	E) for	further	guidance on allow able	costs It	is	important	to understand	that	“allow able	costs”	under	feder al	aw ards	do	not necessaril y	include	all	costs	that the	organization	will	incur	in	order	to	perform	their awards.		The	cost	principles reflect	gov ernment - wide requirements that	one	must	be aware	of	when	developing	a	budget
. **B. Matching	Funds**  The	non
- feder al	share	of	the R ecipient’s budget	represents	the	dollar
- fo r - dollar cash and in
- kind contributions matching	requirement.		A ny	organization	that	receiv es	a PFS award	is	responsible	for securing	the	necessary	match
. Both	the R ecipient s and	the S ub R ecipients and	Service	R eceipients m ust	provide	a	dollar
- for
- dollar	match. The	non
- feder al	dollar	component	of	the	m atch must	equal	at	least	50%	of	the	match and may	come	from	state,	local,	or	priv ate	sources,	which	may	include	state	or	local government agencies,	businesses,	private	philanthropic	organizations,	or	individuals. Fe der al	funds	may	not	be	used	tow ards	the	match	requirement. Fo r	Receipients,	t he in
- kind contributions component	of	this	match	may	not	ex ceed 50%	of	the	match	and must be fully described, valued and publicized in the R ecipient application.
. Third part y in

- kind contributions means the value of non

- cash contributions provided b y non - Federal third parties. Third party in

- kind contributions may be in the form of equipment, supplies and other expendable property , and the value of goods and services directly benefiting and specificall y identifiable to the project or program, or the monetary value of time contributed by professional and technical personnel and other skilled labor. The co ntributions or services provided must be a strategic, integral and necessary part of a funded project for which the R ecipient , Sub

- Recipient or Service Receipient would otherwise have to pay
. The value of the services must be determined by the organization providing the service and must be what the organization normally charges for the services or, if fees are not charged, at the amount the service costs the organization, such as costs for staf f time, required travel, office space, and allocation of indirec t expenses. The total non - feder al	share	of	the Re cipient’s budget	must	equal	or	ex ceed	the	feder al share	of	the	budget	(this	implements	the	dollar
- for
- dollar	match	requirement). However ,	t here	is	no	r equirement	that	the	non
- feder al	share	of	the	budget	“mirror”	or be	allocated	on	the	same	basis	as	the	feder al	share	of	the	budget. Fo r	Sub
- Re cipients	and	Service Re cipients ,	the	in
- kind	contributions	component	of	this match	may	account	for	1 00%	of	the	match .		The	v alue	of	the	contributions	must	be10



### determined	by	the	organization	providing	the	service	and	must	be	what	the organization	normally	charges	for	the	services	or ,	if	fees	are	not	charged,	at	the	amount the	service	costs	the	organization ,	such	as	costs	for	staff	time,	required	tr ave l,	office space,	and	allocation	of	indirect	expenses.
**C. Budget**  **Line	Items Section	I.	Progr**  **am	Costs**  

### Project **Pe rsonnel	Expenses**  List	each	staff	position	separ ately	with	a	brief	statement	of	responsibilities, salary, and the	percentage	of	staff	time	that	will	appl y	to	the cooper ative agreement .	Each	staff	person ’s	role	listed	in	the	budget	must	be	described	in	the application	narr ative	and	each	staff	person	mentioned	in	the	narr ative	must	be listed	in	the	budge t	as	either	CNCS	or Re cipient share.

 

### Pe **rsonnel	F ringe	Benefits**  Include	costs	of	benefit(s)	for the	project	staff. Identify	the	types	of	fringe benefits	to	be	cov ered	and	the	costs	of	benefit(s)	for	each	staff	position. Allow able	fringe	benefits	typicall y	include	FICA,	W ork er’s	Compensation, Re tirement,	SUT

A,	Health	and	Life	Insur ance,	IRA,	and	401K.	Y ou	may	provide	a calculation	for	total	benefits	as	a	percentage	of	the	salaries	to	which	they	appl y or	list	each	benefit	as	a	separ ate	item.	If	a	fringe	benefit	amount	is	ov er	30%, please	list each covered item	separ ately including	the	percentage	charged and justify	the	hi gh	cost.	Holidays,	leav e,	and	other	similar	v acation	benefits	are	not included	in	the	fringe	benefit	r ates,	but	ar e	absorbed	into	the	personnel expenses	(salary)	budget	line	item.

 

### Staff	T **rave l**  Describe	the	purpose	for	which project staff	will	tr ave l. A llow able costs are tr ansportation,	lodging,	subsistence,	and	other	related	expenses. Provide	a calculation	that	includes	itemized	costs	for	airfare,	tr ansportation,	lodging,	per	diem, and	other	tr ave l
- related	expenses	multiplied	by	the	number	of	trips/sta ff.	Where applicable,	identify	the	current	standard	reimbursement	r ate(s)	of	the	organization for	mileage,	dail y	per	diem,	and	similar	supporting	information.	R eimbursement should	not	ex ceed	the	feder al	mileage	r ate	unless it	is a	result	of	applicant	polic y	and it	is justified	in	the	budget	narr ative.	Only	domestic	tr ave l	is	allow able. Include	costs for key project staff	to	attend a c onvening of	Pay	for	Success	Pilot R ecipients
. E xample of	budget	detail	required : The	project	lead will conduct	a	monitoring visit : 1 person X	$750	airfare	+	$50	ground	transportation	+	$ 150 lodging +	$35	per	diem X		two	days =	$ 1 , 1 70 for Monitoring
.

 

### Equipment Equipment	is	defined	as	tangible,	non
- expendable	personal	property	having	a	useful life	of	more	than	one	y ear AND an	acquisition	cost	of	$5,000	or	more per	unit (including	accessories,	attachments,	and	modifications). If	applicable,	show	the	unit11



### cost	and	number	of	units	y ou	are	requesting.	Pr ovide	a	brief	justification	for	the purchase	of	the	equipment	under	Item/P urpose. Yo u	might	be	ask ed	to	provide further	explanation	of	equipment	costs	that	ex ceed	10%	of	the	total	CNCS	funds requested. Any	items	that	do	not	meet	this	definition	should	be	entered	under Supplies.

 

### Supplies Include	the	funds	for	the	purchase	of	consumable supplies	and	materials	that	do not fit	the	definition	abov e. Applicants must	individually	list	any	single	item	costing $1,000	(one	thousand)	or	more. Applicants should	provide	the	calculation	for c o s t dete rminations.

 

### Contractual	and	Consultant	Services I nclude	costs	for	consultants	related	to	the	project’s	oper ations ,	except tr aining or	ev aluation	consultants	who	should	be	listed	in	those	sections .		Wher e applicable,	indicate	the	dail y	r ate	for	consultants.

 

### Tra **ining** I nclude	the	costs	associated with	tr aining	of	staff	working	directl y	on	the p roject,	especiall y	tr aining	that	specificall y	enhances	staff	project implementation	and	pr ofessional skills
. If	using	a	consultant(s)	for	tr aining, indicate	the	estimated	dail y	r ate.

 

### Eva **luation** Include	costs	for	project	evaluation	activities,	such	as the use	of	ev aluation consultants, the purchase	of	instrumentation	and	other	costs	specificall y	for this activity

.		Indicate	dail y	r ates	of	consultants,	where	applicable.

 

### Other	Costs Sub awards
- Please	enter	all	sub award costs	in	a	line	titled,	“ Sub awards .” Criminal	History	Checks
- Please	include	a	line	titled “ Criminal	History	Checks”	and enter the costs	for	criminal	history	background	checks	for	all	employees	or	other individuals	who	receive	a	salary,	stipend , or	similar	payment	from	the cooperative agreement (CNCS	or	non
- CNCS	share). Please	note	that	criminal	history	checks	are required	at	both	th e R ecipient and S ub R ecipient levels. Other	allow able costs	in	this	section	may	include	office	space	rental,	utilities, and	telephone	and	Internet	expenses	that	directl y	involve	program	staff	and	are not	part	of	the	organization ’s	indirect	cost ra te . If	shared	with	other	projects	or activities,	y ou	must	pror ate	the	costs	equitabl y. List	each	item	and	pr ovide	a justification	in	the	budget.

 

### Indirect **Costs** Indirect costs	are those	costs	incurred	for	a	common	or	joint	purpose	benefitting more	than	one	co st	objectiv e,	and	not	readil y	assignable	to	the	cost	objectiv es12



### specificall y	benefitted,	without	effort	disproportionate	to	the	results	achiev ed
. As prescribed	in	the Notice ,	this	category	may	not	ex ceed	20%	of	the	budget. These costs	may	include	administr ative	staff	positions,	rent,	IT	costs,	etc.

 If	y ou	hav e	a	feder all y	approv e d	indirect	cost	(IDC)	r ate	y ou must use	it	unless authorized	by CNCS to	use	another	method.		Specify	the	Cost	T ype	for	which	y our organization	has	current	documentation	on	file, i.e.,	Pr ovisional,	Predetermined, Fix ed,	or	Final	indirect	cost	r ate ,	and	specify	the	cognizant	agency	for	indirect costs .		Suppl y	y our	appr oved	IDC	rate	(percentage

 If	y ou	do	not	hav e	an	IDC, indirect costs	should	be	entered	as	direct	expenses.

 If	y ou are a	nonprofit	organization	or	an	institution	of	higher	education	and	hav e nev er	had an	IDC, instead	of	entering indirect costs	as	direct	costs, yo u	could	also enter	an	amount up	to 10%	of yo ur modified total direct	costs.		Modified total direct	costs are	di rect	salaries	and wa ges,	applicable fringe	benefits, materials and supplies,	services , trave l , and sub	aw ards and	subcontr acts	up	to	the	first $25,000	of	each	subaw ar d or subcontr act (regardless	of	the	period	of performance	of	the	subaw ards	and	subcontr act s	under	the	aw ard)
. See	2	CFR § 200.68 and	§200.414(f ) for	more	information).

 If	y ou	do	not	hav e	an	IDC,	y ou	may	negotiate	with	y our	cognizant	agency	for indirect	costs	for	an	IDC	r ate.		See	2	CFR	§200.414(e)	for	information	on	how	to submit	a	proposal.		S ee	2	CFR	§200.19	to	find	out	who	y our	cognizant	agency	for indirect	costs	is.

 

### Source	of **Matching	Funds** Describe	the r e cipient match	contribution by	entering a	brief description,	the amount,	the	match	classification	(Cash ,	In
- kind ,	or	Not	A va ilable)	and	Match	Source (State/Local,	Priv ate,	Other	or	Not	A va ilable) **for	y our	entire	match.**  Define	any acronyms	the	first	time	they	are	used. Each	source	should	be	entered	as	a	separ ate line	item. Fo r	example, if	y ou	receive	support	from	tw o	separ ate	foundations,	enter each	one	on	a	separ ate	line. Note:	Y ou	will	be	prev ented	from	validating	y our	budget	in	eGr ants	if	y ou	do not	meet	the dollar
- for
- dollar match.		Y ou	will	receiv e	an	error	message	that	states,	“Gr antee	share	must be	greater	than	or	equal	to	CNCS	share. ” 

### VII. **Review**

**,	Authorize,	and	Submit**
e Gr ants	requires	that	y ou	review	and	v erify	y our	entir e	application	before	submitting by completing	the	following steps :  Review  Authorize  Assur ances  Certifications  Ve rify  Submit13



### Re ad	the	Assur ances	and	Certifications carefully	(Attachment	A).	The	person who authorizes	the	application	must	be	the	applicant’s	Authorized	R epresentativ e	or	his/her designee	and	must	hav e	an	acti ve eGr ants	account	to	sign	these	documents	electronicall y. An	Authorized	Representativ e	is	the	person	in	y our	organization	authorized to	accept	and commit	funds	on	behalf	of	the	organization.	A	copy	of	the	gov erning	bod y’s	authorization for	this	official	representativ e	to	sign	must	be	on	file	in	the	applicant’s	office. Be	sure	to	check	y our	entire	application	to	mak e	sure	that	there	ar e	no	errors	before submitting	it.	eGr ants	will	also	gener ate	a	list	of	errors	if	there	are	sections	that	need	to	be corrected	prior	to	submission	when	y ou	v erify	the	application.	If	someone	else	is	acting	in the	role	of	the	applicant’s	authorized	represent ative,	that	person	must	log	into	his/her eGr ants	account	to	proceed	with	Authorize	and	Submit.	After	signing	off	on	the Authorization,	Assur ances,	and	Certifications,	his/her	name	will	ov erride	any	previous signatory	that	may	appear	and	show	on	the	applica tion	as	the	Authorized	Representativ e. **Note:	Anyone	within	your	organization	who	will	be	entering	information	in	the application	at	any	point	during	application	preparation	and	submission	in	the	eGrants**  **system	must	have	their	own	eGrants	account.** Individu als	may	establish	an	eGr ants account	by	accessing	this	link: https://egr ants.cns.gov/espan/main/login.jsp and	selecting “Don ’t	have	an	eGr ants	ac count?		Create	an	account. ”i 

## CO **NTINU**

**AT ION	REQUES**  **TS** These	instructions	appl y	onl y	to	progr ams	that	are	in	y ears	one	through	four	of	a	SIF cooper ative	agreement and are	requesting	funding	for	the	next	y ear . •	Log	into	eGr ants •	On	y our	eGr ants	Home	Page,	under	Creating	a	Gr ant	Application,	select Continuatio n/R enew al •	Select	Continue	from	the	options	listed	to	the	right	of	y our	SIF cooperativ e	agreement .	Do not	start	a	new application.	If	y ou	have	more	than	one	gr ant or	cooper ati ve agreement with the	Corpor ation,	be	sur e	to	select	the correct	one.	The	system will	copy	y our	most	recentl y awarded	application. •	Select	Next	on	the	scr een	that	opens **APPLICA TION	CONTENT**  Yo ur	application	consists	of	the	following	components.	Mak e	sure	to	review	each	section. I.	Applicant	Info II.	Application	Info III.	Narr atives IV .	P erformance	Measures V. Documents VI.	Budget VII.	Review

,	Authorize,	and	Submit **I.	Applicant	Info** Update	this	section	if	necessary
. •	In	particular

,	click **View/Edit** under **Project	Director** to	see	if	the	contact	information	is current.	Mak e	any	necessa ry	changes	to	the	project	director’s	contact	information. •	If	the	project	director	has	changed,	y ou	must	create	a	record	for	the	new	person	by clicking **Enter	New** .	DO	NOT	ov erwrite	the	information	for	an	existing	contact	with	the information for	a	new	cont act	because	this	affects	the	historical	record. •	Document	in	the **Continuation	Changes** field	any	changes	y ou	hav e	made	to	this	section. **II.	Application	Info** Update **Areas	affected	by	the	project** and **Delinquent	on	any	federal	debt** as	necessary .	Do not adjust	the	project	period	dates. **III.	Narr ati** **ve s**  Please	compl y	with	the	page	limit	listed	in	the	Notice.	Preview	the	eGr ants	PDF	of	y our application	to	ensure	that	y ou	don ’t	ex ceed	the	page	limit	as	prescribed	in	the	Notice. •	Y our	original	application will	appear	in	the	different	sections	of	the	Narr atives	screen. Do	not	enter	continuation	changes	in,	or	otherwise	edit,	the	original	narr ative	fields.ii



### Instead	provide	the	information	described	below	in	the	narr ative	field	called **Continuation	Changes.** •	If yo u	have	previously	requested	continuation	funding,	please	distinguish	this	y ear’s	text from	previous	by	labeling	this	y ear’s	narr ative	“Y ear	___( ex: 2	,	3)	Continuation Changes”
. •	Please	enter	narr ative	for	the	following	topics,	clearly	labeling	each	wi th	a	new	heading:

− Changes	to **Applicant	Info** or **Application	Info** Screens:	As	applicable,	note	any changes yo u	have	made	to	the **Applicant	Info** and **Application	Info** screens.

− Changes	in	Staff:	If	applicable,	describe	changes	in	k ey	staff	positions.	If	any key positions are	currently	v acant,	describe	how	the	functions	are	being	carried	out	and when	the positions	will	be	filled.

− Continuations	review	criteria	outlined	in	the	Notice:	Provide	a	narr ative	response	to the review	criteria.

− Changes	to	Budget:	If applicable,	pr ovide	a	r ationale	for	any	proposed	changes	to	the budget. **IV .	P**  **erformance	Measures** Update	this	section	as	necessary .	In	the **Continuations	Changes** narr ativ e	section,	identify describe	any	performance	measures	changes	made. **V. Documents**  In addition	to	the	application	submitted	in	eGr ants,	y ou	are	required	to	complete	and submit	a table	summarizing	y our	sub award * awards	to	date	as	directed	in	the	Notice.	The table	can	be found	in	Attachment	B.	This	information helps	us	to	understand	the	amou nt	of feder al	dollars that	are	flowing	to	the	local	communities.	This	information	is	also	used	to va lidate	the	SIF’s claim	that	it	effectiv el y	lev er ages	priv ate	match	sources.	These	charts	will be	prepopulated based	on	previous	y ear’s	submissions.	Please update	where	applicable	for a	previous	y ear	and complete	the	section	for	y our	current	y ear	of	sub award * awards.	Items included	in	the	chart	are	by subrecipient * :

− Ye ar	___	A

wa rd	(Start	and	End	Date)

− Ye ar	___	A

wa rd	Amount	(F eder al)

− Ye ar	___	A

wa rd	Amoun t	( Re cipient * Match)

− Ye ar	___	A

wa rd	T otal	(F eder al	and Re cipient * Match )	* *

− Ye ar	___ Subrecipient or	Service	Recipient * Match	Funds	Receiv ed (if	applicable)

− Ye ar	___ Subrecipient or	Service	Recipient * Match	Funds	Expended (if	applicable)

− Ye ar	___ Subr e cipient or	Service	Recipient * Fe der al	Funds	Expended

− Ye ar	___ Re cipient* Funds	Expended

- To tal Subrcipient* Funds	Expended	(cumulativ e	to	date)

− To tal Subrecipient Fe der al	and	Intermediary	Funds	A wa rded	(cumulativ e	to	date)*

− To tal Subrecipient Match	F unds	R eceiv ed	(cumulativ e	to	date)*	15

− To tal Subrecipient Match	Funds	Expended	(cumulativ e	to	date)*

− To tal Subrecipient Fe der al	Funds	Expended	(cumulativ e	to	date)*

− To tal Subrecipient Intermediary	Funds	Expended	(cumulativ e	to	date)*

− To tal Subrecipient Fe der al	Funds	Expended	(cumulativ e	to	date)*iii



### − To tal Subrecipient Funds	Expended	(cumulativ e	to	date)*After	y ou	ha ve submitted	the table	as	requested,	change	the	status	in	eGr ants	from	the	default **Not	Sent** to	the	applicable status **Sent** .	Submit completed	spreadsheets	to	y our	progr am officer	via	email	by	the application	due	date.

* Fo r	2015	onw ard,	terminology	has	changed	and	is	consistent	with	the	changes	in Title	2 of	the	Code	of	F eder al	Regulations	(2	CFR	Part	200 ).		As	a	result,	an intermediary	is	now defined	as	a	recipient,	a	subgr antee	is	a	subrecipient,	and	a	subrecipient	onl y	receiving services,	but	no	feder al	money ,	is	a	service	recipient.

* * Will	automaticall y	populate **VI.	Budget** Yo ur	budget	from	the	previous	y ear	will	be	co pied	into	y our continuation	request.	Mak e	any necessary	adjustments	to	the	existing	budget. **VII.	R ev**  **iew**

**,	A uthorize,	and	Submit**  Re ad	the	Assur ances	and	Certifications	carefull y	(Attachment	A).	The	person who authorizes	the	application	must	be	the	applican t’s	Authorized	Representativ e	or	his/her designee	and	must	hav e	an	acti ve eGr ants	account	to	sign	these	documents	electronicall y. An Authorized	Representativ e	is	the	person	in	y our	organization	authorized	to	accept	and commit funds	on	behalf	of	the	organiz ation.	A	copy	of	the	gov erning	bod y’s	authorization for	this	official representativ e	to	sign	must	be	on	file	in	the	applicant’s	office. Be	sure	to	check	y our	entire	application	to	mak e	sure	that	there	ar e	no	errors	before submitting	it. eGr ants	will	also gener ate	a	list	of	errors	if	there	are	sections	that	need	to	be corrected	prior	to submission	when	y ou	v erify	the	application.	If	someone	else	is	acting	in the	role	of	the applicant’s	authorized	representativ e,	that	person	must	log	into	his/her eGr ants	acc ount	to proceed	with	Authorize	and	Submit.	After	signing	off	on	the Authorization,	Assur ances,	and Certifications,	his/her	name	will	ov erride	any	previous signatory	that	may	appear	and	show	on the	application	as	the	Authorized	R epresentativ e.iv



## AT **TA CHMENT**  **A :	Assur**  **ances	&	Certifications**

**A SS**  **UR A**  **N C**  **ES** A s th e du ly autho riz e d r e p r e s e n t at i v e o f th e app l i can t , I assure , to t h e b e st o f m

y kn o w le d g e an d b e l i e f

, th at th e app l ic an t:

 H a s t h e le g a l autho ri ty to ap p ly f o r f e d e r a l a s s istan ce , an d th e i n st i tut i o n a l, m an age rial, an d f i n an c ial cap ab i l i ty (i n c l u d i n g f und s s u ff i c ie n t to p ay t

h e n o n - f e d e r a l s h are o f p r o

je c t c o sts) to e n s ure p r op e r p lan

n i n g , ma n ag e me n t, an d c o m

p leti o n o f th e p r o

je c t d e s c ri be d in t

h is ap p l i ca t i on .
 W i l l g i v e th e aw ar d i n g ag e nc y , th e C o m p tr o l l e r G e n e r a l o f th e Un i t e d S tat e s, an d if app r o p riat e , t h e s t ate, thr o u g h any autho r iz e d r e p r e s e n tati ve , acce ss to an d t h e ri g h t t o exami n e a ll r e co r d s, b o o k s, p ap e rs, o r do c um e n ts r e lat e d to th e aw ar d ; an d w i l l e st ab l i sh a p r o p e r acc oun t i n g s y s t e m in acc o r d an c e w i t

h ge n e r a l l y a c ce p ted acc oun t i n g st and a r d s o r age nc y d ire c t iv e s.

 W i l l e st ab l i sh s a f

e gu a r d s to p r o h i b it e m

p l o ye e s f r o m u si n g th e ir po sit io n f o r a pur po se t h at co n sti tut e s o r p r e s e n ts t

h e a pp ear an c e o f p e rs on a l o r o r gan i z a t ion a l co n f l i c t o f i n ter e st, o r p e r s on a l ga i n .
 W i l l i n i t iate an d c o m p lete t h e w o rk w i th i n th e ap p l i ca b le ti m e f r a m e a f ter r e ce i p t o f app r o va l o f th e aw a r d i n g a g e nc y .
 W i l l c o m

p l y w i th th e In ter g o ve rnme n tal P e rs o nn e l A c t o f 197 0 ( 4 2 U. S .C. 4 7 2 8
- 4 7 63 ) r e lati n g to p r e s c ri b e d st and ar d s f

o r m e rit s y st e m s f

o r p r o g r am s f

und e d un d e r o n e o f th e n i n e te e n s t a tutes o r r egu lati o n s s p ec i f

ied in A pp e nd ix A o f O P M ’s S tan d a r d s f o r a M e rit S y s t e m o f P e rs o nn e l A dmi n istrati o n ( 5 C F R 9 0 0 , S u b p art F )
.
 W i l l c o m

p l y w i th a ll f

e d e r a l st a tutes r e lati n g to n o n d is c ri mi n a t ion
. T h e se i n c l ud e b ut a re n o t l i mi t e d t o : (a) T i t le V I o f th e Ci v il Ri g h ts A c t o f 196 4 ( P
. L
. 8 8
- 3 5 2 ) w h ich p r oh i b i t s d is c ri mi n a t io n o n th e b a sis o f r ace , c o l o r, o r n a t i o n a l o ri g i n ; ( b ) T i t le IX o f th e E du cat i o n Ame ndme n ts o f 19 7 2 , a s ame nd e d ( 2 0 U
. S .C. 1 6 8 1
- 1 6 83 , an d 1 6 8 5
- 1 6 8 6 ) w h ich p r o h i b i t s d is c ri mi n a t io n o n t h e b a sis o f s e x ; ( c ) S ec t io n 5 0 4 o f th e R e h a b i l i t at io n A c t o f 197 3 , a s ame nd e d ( 2 9 U. S .C. 7 9 4 ), w h ich p r o h i b i t s d is c ri mi n at io n o n th e b a sis o f d is ab i l i ty ( d) T h e A g e Dis c r i mi n at io n A c t o f 19 7 5 , a s am e nd e d ( 4 2 U. S .C. 6 1 0 1
- 6 1 07 ), w

h ich p r oh i b i t s d is c ri mi n a t io n o n th e b a sis o f age ; ( e ) T h e Dr u g A bu se Of f i c e an d T r eatm e n t A c t o f 19 7 2 ( P
. L
. 9 2
- 2 5 5 ), a s ame nd e d , r e lati n g t o n o nd is c ri mi n a t io n o n th e b a sis o f dr u g ab u s e ; ( f

) T h e C o m

p r e h e n si v e A lc oho l A

bu se an d A lc oh o l i sm P r eve n t ion , T r eatm e n t an d R e h a b i l i t a t io n A c t o f 197 0 ( P
. L
. 9 1
- 6 16 ) , a s a m e nd e d , r e lati n g to n o nd is c ri mi n a t io n o n t h e b a sis o f a lc o h o l ab u se o r a lc o h o l i s m ; ( g ) s ec t ion s 5 2 3 an d 5 2 7 o f th e Pub l i c H ea l t h S e rv ice A c t o f 191 2 ( 4 2 U. S .C. 2 90 d d

- 3 an d 2 90 e e - 3 ), a s ame nd ed , r e lati n g to c on f i d e n t i a l i ty o f a l c oh o l an d dr u g abu se p a t i e n t r ec o r d s; ( h ) T i t le V I II o f th e Ci v il Ri g h ts A c t o f 19 6 8 ( 4 2 U
. S .C. 3 6 0 1 e t s e q .), a s ame nd e d , r e lat i n g to no n d is c ri mi n a t io n in th e s a le, r e n t a l o r f i n an c i n g o f h ou s i n g ; (i) any o th e r n o n d is c ri mi n at io n p r o v isi o n s in th e N at i o n a l an d C o mm un i ty S e r v ice A c t o f 1 99 0 , a s ame nd e d ; an d ( j) t h e r e qu i r e m e n ts o f an y o th e r n o n d is c ri mi n a t i o n st atute( s ) w h ich m ay app l y to th e ap p l i ca t i o n .
 W i l l c o m

p l y , o r h a s alr ea dy c o m

p l i e d , w i t h t h e r e qu ire me n ts o f T i t les II an d III o f th e Un i f o rm R e l o c a t io n A s s istan c e an d R ea l P r op e rty A c qu isi t i o n P o l i c ies A c t o f 19 7 0 ( P
. L
. 9 1
- 6 4 6 ) w h ich p r o v i d e f o r f a ir an d equ i t a

b le tr eatm e n t o f p e rs on s d is p la ce d o r w ho se p r o p e rty is ac qu ired a s a r e s u lt o f f e d e r a l o r f

e d e r a l l y a s s isted p r o g r a m s. T h e se r e qu ire me n ts ap p ly to a ll i n ter e sts in r ea l p r o p e rty ac qu ired f

o r p r o j ec t pur p o s e s re g a

r d le s s o f f

e d e r a l p art i c i p at i o n i n pur c h a s e s.v

 W i l l c o m

p l y w i th th e p r o v isi on s o f th e H a tch A c t (5 U. S .C. 1 5 0 1
- 15 0 8 an d 7 3 2 4
- 7 3 28 ) w h ich l i mit th e p o l i tic a l ac t i v i t ies o f e m p l o yee s w

ho se p ri n c i p a l e m

p l o yme n t ac t i v i t ies a

re f und e d i n w ho le o r in p art w i th F e d e r a l f und s.

 W i l l c o m

p l y , a s app l i cab le, w i th t

h e p r o v is i on s o f th e D av i s - B ac o n A c t ( 4 0 U. S .C 2 7 6 a an d 2 7 6 a 7 7 ) , th e C op e lan d A c t ( 4 0 U. S .C 2 7 6 c an d 1 8 U. S
. C
. 8 7 4 ), an d th e C on tra c t W o r k H o urs an d S a f e t y S tand ar d s A c t ( 4 0 U. S .C. 3 2 7
- 3 33 ), r egar d i n g labo r st an d ar d s f o r F ede r a l l y a s s isted c on str u c t i o n s u b

- ag r e e me n ts.

 W i l l c o m

p l y , if app l i cab le, w i th f

l oo d i n s ur an c e p u

r c h a se r e qu ire me n ts o f S ec t io n 1 0 2 ( a ) o f th e F l oo d Dis a st e r P r o te c t i o n A ct o f 19 7 3 ( P
. L
. 9 3
- 2 34 ) w h ich r equ ires t

h e r ec i p ie nts i n a s p ec ial f l oo d h azard ar e a to p a

rt i c i p ate in th e p r o g r am an d to pur c h a se f l oo d i n s ur an c e if th e t o tal c o st o f i n s ur a b le c on str u c t i o n an d ac qu isi t i o n is $1 0 , 0 0 0 o r mo r e .
 W i l l c o m

p l y w i th e nv ir onm e n t a l st and a r d s w h ich may b e p r e s c ri b e d p urs u an t to th e f o l l o wi n g : ( a ) i n sti tut i o n o f e nv ir onm e n tal qu a l i ty c on tr o l m e a s ur e s und e r t h e N at i o n a l E nv ir o nm e n tal P o l i c y A c t o f 196 9 ( P
. L
. 9 1
- 1 9 0 ) an d E xec ut i v e Or d e r (EO) 1 1 51 4 ; ( b ) no t i f ic at io n o f v i o lati n g f

ac i l i t ies purs u a n t t o EO 1 1 7 3 8 ; ( c ) p r o te c t i o n o f w e t l and s purs u a n t t o EO 1 1 9 9 0 ; ( d ) eva l u a t io n o f f l oo d h azar d s in f

l o o d p lai n s in acc o r d an c e wi th EO 1 1 9 8 8 ; ( e ) a s s ur an c e o f p r o je c t co n sist e n c y w i th th e ap p r o ve d st a te m ana g e me n t p r o g r am d eve l op e d u n d e r t h e C o a s t a l Z on e M an ag e m e n t A c t o f 19 7 2 ( 1 6 U
. S .C 1 4 5 1 e t s eq .); (f ) c on f o r mi t y o f f

e d e r a l ac t ion s to S tate (Cle an A ir) I m p l e m e n tati o n P lan s un d e r S ec t io n 1 7 6 ( c ) o f th e Cle an A ir A c t o f 19 5 5 , a s ame nd e d ( 4 2 U. S
. C
. 7 4 0 1 e t s e q .); ( g ) p r o te c t io n o f und e r g r o un d s our c es o f dri nki n g w ater und e r t h e S a f e Dri nki n g W ater A c t o f 1 9 74 , a s ame nd e d ( P
. L
. 9 3
- 5 2 3 ); an d ( h ) p r o te c t io n o f e nd an ge r e d s p ec ies un d e r th e E ndan ge r e d Sp ec ies A c t o f 19 7 3 , a s ame nd e d ( P
. L
. 9 3
- 2 0 5 ).

 W i l l c o m

p l y w i th th e W i l d an d S ce n ic Ri ve rs A c t o f 196 8 ( 1 6 U. S
. C 1 2 7 1 e t s e q .) r e lat e d t o p r o te c t i n g c o m

pon e n ts o r po te nt i a l c o m

pon en ts o f th e n a t i o n a l w i l d an d s ce n ic r i ve rs s y st e m .
 W i l l a s s ist th e aw a

r d i n g a g e nc y i n a s s uri n g c o m p l i an c e w i th S ec t io n 1 0 6 o f th e N a t i on a l His t o ric P r e s e rv a t io n A c t o f 19 6 6 , a s ame n d e d ( 1 6 U. S .C. 4 70 ), EO 1 1 5 9 3 (i d ent i f ic at io n an d p r o te c t io n o f h is t o ric p r op e rt i e s), an d th e Ar c ha e o l o g ic a l an d His t o ric P r e s e rvat io n A c t o f 197 4 ( 16 U
. S .C. 4 69 a - l e t s eq .).

 W i l l c o m

p l y w i th the National Research Act, P
. L
. 9 3
- 3 4 8 r eg ar d i n g th e p r o te c t i o n o f hum an s u b je c ts i nv o l ve d i n r e s ear c h , d eve l op m e n t, an d r e lat e d ac t i v i t ies s up p o rted b y th is aw a rd o f a s s istan ce .
 W i l l c o m

p l y w i th th e L abo r a t o ry An i ma l W e l f a re A c t o f 196 6 ( P
. L
. 8 9
- 5 44 , a s ame nd e d , 7 U. S
. C
. 2 13 1 e t s e q .) p e rtai n i n g t o t h e car e , h an d l in g , a

n d tre atm e n t o f w ar m b l oo d e d an i ma ls h e ld f o r r e s ear c h , te ac h i n g , o r o t

h e r ac t i v i t ies s up p o rted b y th is aw ard o f a s s ist a n ce .
 W i l l c o m

p l y w i th th e L ea d

- B a s e d P a i nt Po i s on i n g P r eve n t io n A c t ( 4 2 U
. S .C. § § 4 8 0 1 e t s e q .) w h ich p r o h i b i t s th e u se o f le a d b a s e d p a i n t in c on st r u c t i o n o r r e h ab i l i tati o n o f r e si d e n c e st r u c tur e s.

 W i l l cau se to b e p e r f

o rm e d th e r e qu ired f

i n an c ial an d c o m

p l i an c e aud i t s in acc o r d a

n c e wi th th e S i n g le A ud it A c t o f 19 8 4 , a s ame nd e d , an d 2 C.F .R. Part 200, Subpart F
.
 W i l l c o m

p l y w i th a ll app l i cab le r e qu ire me n ts o f a ll o th e r F e d e r a l l aw s , ex e c ut i v e o r d e rs, r egu lati o n s , app l ic at io n gu i d e l in e s, an d po l i c ies g o ve rn i n g th is p r o g r am .
 Will comply with the pilot program on Contractor employee whistleblower protectionsvi

established at 41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2013 (Pub. L. 112

- 239).  This award and employees working on this award will be subject to the whistlebl ower rights and remedies in the pilot program.  Under this pilot program, an employee of a recipient ma y not be discharged, demoted, or otherwise discriminated against as a reprisal for disclosing information that the employee reasonably believes is evidenc e of gross mismanagement of a Federal contract or grant, a gross waste of Federal funds, an abuse of authority (an arbitrary and capricious exercise of authority that is inconsistent with the mission of CNCS or the successful performance of a contract or award of CNCS) relating to a Federal contract or award , a substantial and specific danger to public health or safety, or a violation of law, rule, or regulation related to a Federal contract (including the competition for or negotiation of a contract) or aw ard
.  The recipient shall inform its employees in writing, in the predominant language of the workforce or organization, of employee whistleblower rights and protections under 41 U.S.C. 4712, as described above
.

## CERTIF **I CATIO** **N S**  **Ce rt**  **ific at**  **i o**  **n –**  **Deb a**  **r m**  **en t**  **, S**  **us p**  **e n**  **s i**  **o n,**  **a nd**  **Ot her**  **R e**  **s p**  **o n**  **s i**  **bi l**  **ity M**  **att e**  **rs** T h is c erti f

icati o n is r e qu ired b y th e g o v e r n me n t - w i d e r e gu l a ti o n s i m p l e m e n t i n g E x e c ut i v e O rd er 1 2 54 9 , De b arme n t a

n d S u s p e n s i o n , 2 C F R P ar t 1 80 , Secti o n 180
. 335 , W ha t i n f o rm a ti o n m u s t I p r o vi d

e b ef o r e e n ter i n g i n to a c o v e r ed tran s a cti o n w ith a Fe d era l age n c

y ? As th e du l y a ut h or ized r e pr es e ntat i v e o f t h e app licant, I c ertif y , to t h e b est o f m

y kn o w le d g e a

n d b elie f , th at n ei th er t

h e app lica

n t n o r its pr i n ci p al s :

 I s pr ese nt l y e x c l u d ed o r d i s qu ali f ie d ;  Has b e e n c onv icted w i t h in th e pr e c e d i n g th r ee ye ar s o f any o f th e of f e ns e s li s ted i n § 180
. 800( a) o r h ad a ci v il j u dg m e n t r e n d e r ed a g ai n s t it f o r o n e o f th o s e off

e ns e s wi t h in th at t i m e p e r i od ;  I s pr ese nt l y i n d icted f o r o r o th e r wi s e c r i m

i n al l y o r ci v il l y c h ar g ed b y a g o v e rn m e n tal e n ti t y ( Fe d e r al, State, o r l o c a l) wi th c o mm i s si o n o r any o f t h e of f e n s es l i s t e d in § 180
. 80 0 ( a ) ; o r  Has h ad o n e o r mor e p ub lic tra ns a c ti o n s ( Fe d e r al, State, o r l o c a l) te rm i n ated w i t h i n th e pr e c e d i n g t hr ee y e ar s f

o r c au s e o r d e f

a u l t
. **D e**  **fi n**  **it io**  **n s**  T h e te r m s “ d e b a

r m e n t”, “ s u s p e n si on ” , “exc l ud e d ” , “ d is qu a l i f ie d ” , “ i n e l i g i b le ” , “ p art i c i p ant”, “ p e rs o n ” , “ p r i n c i p a l”, an d “v o l un tarily exc l ud e d ” a s u s e d in th is d o c um e n t h av e th e m e an i n g s s e t out in 2 C F R P art 1 8 0 , s u bp art I, “ D e f

i n i t i on s.” A tran s ac t io n s h a l l b e co n si d e r e d a “c o ve r e d tran s ac t ion ” if it m ee ts t h e d e f i n i t i o n i n 2 C F R p a

rt 1 8 0 s ubp art B, “ C o ve r e d T r an s ac t ion s.” **A s**  **sur a**  **n c**  **e r**  **e q**  **u i**  **r e**  **m e**  **n t**  **f o**  **r su b**  **aw ard**  **a g**  **r ee**  **m e**  **n ts**  Y o u ag r e e b y s ub mi t t in g th is p r o po s a l t h at if w e app r o v e your ap p l i ca t io n yo u s h a ll n o t kn o wi n g l y en ter in t o any l o w e r t i e r c o ve r e d tran s ac t io n wi th a p e rs o n w h o is d e b a

rr e d , s u s p e nd e d , d ec l a

r e d i n e l i g i b le, o r v o l un tar i ly e xc l ud e d f

r o m p art i c i p at i o n i n th is c o ve r e d tran s ac t i o n , un le s s a uth o riz e d b y u s. **A s**  **sur a**  **n c**  **e i**  **n c**  **l u**  **si o**  **n in**  **s ub**  **aw ard**  **a g**  **re e**  **m e**  **n ts**  Y o u ag r e e b y s ub mi t t in g th is p r o po s a l t h at yo u w i l l ob ta i n an a s sur an c e f r o m p r o s p ec t i v e p a

rt i c i p an ts in a ll l o w e r t i e r c o ve r e d tran s ac t ion s an d i n a ll s o l i c i t a t i on s f o r l o w e r t i e r c o ve r e d tra

n s ac t ion s th a t t

h e p art i c i p an ts are n o t d e b arr e d , s u s p e nd ed , i n e l i g i b le, o r v o l un tarily exc l ud e d f r o m t h e c o ve r e d tran s ac t ion
. **A s**  **sur a**  **n c**  **e o**  **f su**  **b award**  **p r**  **i n**  **c i**  **pa ls**  Y o u m a y r e l y upo n an a s s u r an c e o f a p r o s p ec t i v e p a

rt i c i p ant in a l o w e r - t i e r c o ve r e d tran s ac t io n th a t is n o t d e b arr e d , s u s p e nd e d , i n e l i g i b le, o r v o l un tarily exc l ud e d f r o m th e c o ve r e d tran s ac t ion , un l e ss yo u k no w th at th e a s s ur an c e i s err on eo u s. Y o u m a y d ec i d e th e m e tho d a n d f r e qu e n c y b y w

h ich yo u d e term

i n e th e e l i g i b i l i ty o f y our p r i n c i p a ls. Y o u m a y , but are no t r e qu ir e d t o , c h ec k th e L ist o f P art ie s E xc l ud e d f r o m F e d e r a l P r o c ur e m e n t an d N onp r o c ur e m e n t P r o g r am s. **N on**  **- a**  **s s**  **u r**  **a n**  **c e in**  **s u**  **b aw**  **ard a**  **g r**  **ee m**  **e n**  **ts** If y o u kno w i n g l y e n ter in to a l o w e r t i e r c o ve r e d tran s ac t io n wi th a p e rs o n w h o is s u s p en d e d , d e b arr e d , i n e l i g i b le, o r v o l un t a ri l y exc l ud e d f r o m p art i c i pa t io n i n t

h i s tr an s ac t ion , in a dd i t i o n to o t h e r r e m e d ies av a i l ab le to t

h e f e d e r a l g o ve rn m e n t, w e m ay term i n a te th is tran s ac t io n f

o r cau s e o r d e f

au l t
. **C er**  **tif i**  **ca ti**  **o n**  **– D**  **r u**  **g Fr**  **e e**  **W o**  **rk p**  **l a**  **c e**  T h is ce rt i f

i c at io n is r equ ired b y th e C o r po r at i o n ’s re g

u lati on s i m

p le me n t in g s ec t ion s 5 1 5 0
- 5 1 6 0 o f th eDr

u g - F r e e W o rk

p la c e A c t o f 19 8 8 ( P
. L
. 1 0 0
- 6 90 ), 2 CFR Parts 182 and 2245
. T h e r egu lati on s re q u ire c e rt i f ic at io n b y recipients , p ri o r t o aw a r d , th a t t h e y wi l l m ak e a g oo d f

a i th e f f o rt, o n a c on t i nu i n g b a sis, t o m a i n tain a dr

u g - f r e e w o r k p la ce . T h e ce rt i f

i c a t io n s e t o ut b e l o w is a ma teri a l r e p r e s e ntati o n o f f a c t up o n w h ich r e l i an c e w i l l b e p la ce d w h e n th e age n c y d e te r mi n e s to aw ard th e g r an t. F a lse ce rt i f i c at io n o r v i o lati o n o f th e ce rt i f

ic at io n m a y b e g r ound s f

o r s u s p e n si o n o f p aym e n ts, s u s p e n si o n o r term i n a t io n o f g r an ts, o r g o ve rnm e n t - w i d e s u s p e n si o n o r d e b arm e nt (s e e 2 C F R P art 1 8 0 , S u b p arts G an d H). A s th e du ly autho riz e d r e p r e s e n t at i v e o f th e recipient , I ce rt i f y , to th e b e st o f m

y kno w le dg e an d b e l i e f , th a t th e recipient wi l l p r o v i d e a d r u g - f r e e w o rk p la c e b y : A. Pub l is h i n g a dr

u g - f r e e w o r k p la c e st at e m e n t th a t: a. N o t i f ies e m p l o yee s th a t th e un law f

u l m anu f ac tu r e , d istr ibut i o n , d i s p e n si n g , p o s se s s i on , o r u s e o f a c on tr o l l e d s ub st an c e is p r o h i b i t e d in th e recipient ’s w o rk p la ce ; b. Sp ec i f

ies th e ac t ion s th at th e recipient wi l l tak e aga i n st e m p l o yee s f o r v i o lati n g t

h a t p r oh i b i t i on ; an d c. I n f o rm s e m p l o ye e s th a t, a s a c o n d i t i o n o f e m p l o yme n t un d e r any aw ar d , eac h e m p l o ye e w i l l ab i d e b y th e term s o f t h e st a t e m e n t an d n o t i f

y th e recipient in w

ri t i n g if th e e m p l o y e e is c onv ict e d f

o r a v i o lati o n o f a c ri mi n a l dr u g st atute o cc urr i n g in th e w o rk p la c e w i th in f

i v e day s o f th e co nv icti on ; B. R e qu ir i n g th a t a co p y o f th e st at e me n t d e s c ri b e d i n p a r ag r ap h ( A) b e g i ve n to eac h e m p l o ye e w h o will b e e n gage d in th e p e r f o rman c e o f an y F e d e r a l aw a r d ; C. Estab l i s h i n g a dr

u g - f r e e aw ar e n e s s p r o g r am to i n f o rm e m p l o ye e s a bo ut: a. T h e d an ge rs o f dr

u g abu se in th e w o rk

p la ce ; b. T h e recipient ’s po l i c y o f m a i n tai n i n g a dr u g - f r e e w o rk p la ce ; c. An y ava i l ab le dr

u g c o un s e l in g , r e h ab i l i t at i o n , an d e m p l o ye e a s s ist a n c e p r o g r am s; an d d. T h e p e n a l t ies th a t t

h e recipient may i m

po se upo n th e m f

o r dr u g ab u se v i o lati on s o cc urri n g i n t

h e w o rk p la ce ; D. P r o v i d i n g u s, a s w e ll a s any o th e r F e d e r a l age nc y o n w ho se aw a rd t h e c onv ict e d e m

p l o ye e w a s w o rki n g , w i th w

ri t ten no t i f

ic at io n w i th i n 1 0 ca le n d a

r d a y s o f le a rn i n g th at an e m

p l o y e e h a s b ee n c onv ict e d o f a dr

u g v i o la t i o n in t

h e w o rk p la ce ; E. T aki n g on e o f th e f

o l lo w i n g ac t i o n s w i th in 3 0 ca l en d a r d ay s o f le ar n i n g t

h a t an e m p l o ye e h a s b ee n conv ict e d o f a dr

u g v i o lati o n in th e w o rk

p la ce : a. T aki n g app r o p riate p e rs o nn e l ac t i o n aga i n st th e e m p l o yee , u p to an d i n c l ud i n g ter

m i n a t ion ; o r b. R e qu ir i n g th a t t

h e e m p l o ye e p art i c i p a te s a t i s f

a c t o ri l y in a dr

u g ab u se a s s istan c e o r r e h ab i l i t at i o n p r og r a m app r o ve d f o r t h e se pur po s e s b y a F e d e r a l, S tat e , o r l o ca l h ea l th , law e n f o r c e m e n t, o r o t

h e r a pp r op ri a te ag e nc y ; F. M aki n g a g oo d f

a i th e ff o rt to c on ti nu e t o ma i n tain a dr u g - f r e e w o rkp la c e thr o u g h i m p le me n tati o n o f p ar ag r aph s ( A ) thr o u g h (E). **C er**  **tif i**  **ca ti**  **o n**  **- L**  **ob b**  **y i**  **n g**  **A c**  **ti v**  **i t**  **ies** A s re qu ired b y S ec t io n 1 3 5 2 , T i t l e 3 1 o f th e U. S
. C od e , a s t h e d u ly aut h o riz e d r e p r e s e n tati v e o f th e a pp l i can t , I ce rt i f

y , to t h e b e st o f m

y k n o w le d g e an d b e l i e f

, th at:

 No f und s re ce i ve d f

r o m CNCS hav e b ee n o r w i l l b e p a i d , b y o r o n b e h a lf o f th e app l i can t , to any p e rs o n o r age nt ac t in g f o r th e app l i can t , r e lat e d t o ac t i v i t y d e si g n e d to i n f l u e n c e th ee n ac tm e n t o f le g islati on , ap p r o p r iati on s, a dmi n istrati v e ac t ion , p r o po s e d o r p e n d i n g b e f o re th e C on g r e ss o r any S tate g ov e rnme n t, S tate le g islature o r l o ca l le g islature o r le g islati v e bod y .

 If an y f

und s o t h e r t h an f e d e r a l app r o p riat e d f

un d s h av e b ee n p a i d o r w i l l b e p a id to a ny p e rs o n f o r i n f l u e n c i n g o r at te m

p t in g to i n f

l u e n c e an o ff

i ce r o r e m

p l o ye e o f an y a ge nc y , a m e m b e r o f C on g r e s s , an o f

f ic e r o r e m

p l o ye e o f C on g r e s s , o r an e m p l o ye e o f a m e m

b e r o f C on g r e ss in c onn ec t i o n wi th th is f

e d e r a l c on tra c t, g r an t, l o an , o r c oop e r at i v e ag r e e me n t, th e ap p l i c an t w i l l s ub mit S tand ar d F o rm - L L L , " Dis c l o s ure F o rm to R e po rt L obb yi n g ," in acc o r d an c e w i th i t s i n str u c t i on s;

 T h e app l i cant w i l l r equ ire th a t t h e lan gu ag e o f th is ce rt i f

i c at io n b e i n c l u d e d i n t

h e aw ard do c um e n ts f

o r a ll s ub co n tra c ts at a ll t i e rs ( i n c l u d i n g s ub co n tra c ts, s u b award s, an d c o n t

r ac ts und e r awards , l o an s an d co o pe r at i v e ag r e e me n ts) an d t h a t a l l s u b r ec i p i e nts wi l l ce rt i fy an d d is c l o se acco r d i n g l y . **E rr**  **o n**  **e o**  **u s c**  **er tif** 

**ic a**  **ti o**  **n o**  **r a**  **s s**  **u r**  **a n**  **c e**  T h e a s s ur an ce s an d ce rt i f i c a t ion s are m a teri a l r e p r e s e ntati on s o f f a c t u p o n w h ich w e r e l y in d e term

i n i n g w h e t h e r to e n ter i nto t

h is tran s ac t ion
. If w e lat e r d e te rmi n e th a t yo u k no w i n g ly s ub mi t ted an e rr on eo u s c e rt i f ic at io n o r a s s ur a

nce , in ad d i t i o n t o o th e r r e m e d ies av a i l ab le to t h e f e d e r a l g o ve rn m e n t, w e m ay te r mi n ate th is tran s ac t io n f o r cau se o r d e f

au l t
. **N o**  **tice o**  **f e**  **rr o**  **r in c**  **e r**  **tif**

**i ca**  **ti o**  **n o**  **r a**  **s s**  **u r**  **a n**  **c e**  Y o u m u st p r o v i d e imme d iate w

ri t ten n o t i c e to u s if a t any t i m e yo u le arn th a t a ce rt i f ic at io n o r a s s ur an c e w a s e rr on e ou s w

h e n s ub mi t ted o r h a s b ec o m e e rr on e ou s b ecau se o f c h an ge d c irc u m st an ce s. **Pru d**  **e n**  **t p**  **e r**  **s o**  **n st**  **an d**  **a r**  **d** Nothing contained in the aforementioned may be construed to require establishment of a system of records in order to render in good faith the assurances and certifications required. Your knowledge and information is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

## AT **TA CHMENT**  **B :**  **Instructions	for	Cr eating	P**  **erformance Measur**  **es	in	eGrants** In	the	Performance	Measures	module	of	eGrants	you	will	create	performance	measures;	set targets	and	describe	data	collection	plans	for your	performance	measures;	identify interventions	associated	with	your	program;	and	identify	performance	measures	for sub recipient s	(as	applicable) **A. Accessing	the	Performance	Measures	Home	Page**  You	can	either	access	the	Performance	Measures	Module	after	completing	the Documents	section	of	your	application	or	directly	by	clicking	on **Performance Measures**  on	the	left	side	of	your	screen.

 To	begin	entering	performance	measures,	click	the **Begin** butto n	on	the	Home	Page.

 As	you	proceed	through	the	module,	the	Home	Page	will	summarize	your	work and	provide	links	to	edit	the	parts	of	the	module	you	have	completed.		You	may also	navigate	sections	of	the	module	using	the	tab	feature	at	the	top	of	each	pag e.

 Once	you	have	started	the	module,	clicking **Continue	Working** will	return	you	to the	tab	you	were	on	when	you	last	closed	the	module.  To	edit	a	performance	measure,	click	the **Edit** button.  To	delete	a	measure,	click **Delete**
.  To	create	a	new	performance	measure,	click	the **Add	New	Performance	Measure** button. **B. Creating	Performance	Measures**  On	the **Performance	Measures	Tab** ,	you	can create	performance	measures	for	all	the cooper ative	agreement activities	you	intend	to	measure.		Please	note	that	there	are mandatory	measures	for	which	you	must	set	targets	and	report.		There	are	additional measures	that	you	will	select	as	they	pertain	to	your	program. **1.** Select **Applicant	Type: Recipient** 
. **2.** Selec t **Applicant	Name:** Your	organization’s	name. **3.** Enter	a **Problem	Statement:** In	2
- 3	sentences,	briefly	describe	the	problem	that	you propose	to	address	through	your	SIF award activities. **4.** Select **Targets	for	Mandatory	Performance	Measures**  Enter	a	baseline	and target	number	for	mandatory	SIF	performance	measures.  For	each	measure,	select	and	describe	the	instrument(s)	you	will	use	to	measure the	appropriate	output	or	outcome.		Instruments	are	specific	tools	used	to	collect information	such	as	a	behavior	checklis t,	attitude	questionnaire,	attendance sheet,	or	interview	protocol.		Include	the	title	of	the	instrument(s),	a	brief description	of	what	it	measures	and	how	it	will	be	administered,	and	details about	its	reliability	and	validity	if	applicable.

### 5. **Add	Additio nal	Performance	Measures** 

Select	additional	measures	if	they	are	applicable	to	your	program.		Consult	the	SIF Performance	Measures	Definitions	guidance	to	determine	which	performance measures	are	appropriate	for	your	program.  Select	a	focus	area	and	relev ant	outputs	and/or	outcomes.		Enter	a	baseline	and target	number	for	each	measure.  For	each	measure,	select	and	describe	the	instrument(s)	you	will	use	to	measure your	output	or	outcome.  To	create	additional	measures,	select **Add	Another	FA	End	Outcome** (FA=Focus Area)	and	select	desired	focus	areas,	outputs,	and	outcomes,	as	appropriate. **6. Identify	Interventions**  Select	the	interventions	that	you	will	carry	out	to	address	the	problem	identified	in the	application.		Only	interventions	that	correspond	with	t he	focus	area(s)	you selected	will	appear.  Select	all	interventions	that	are	a	part	of	your	program	design.  Click **Add	User	Intervention** to	add	and	describe	any	intervention	not	listed. **7. Saving	Performance	Measures**   After	entering	all	information,	select, **Complete	PM** .		This	will	return	you	to	the Home	Page.  If	you	are	an	existing	SIF recipient and	wish	to	create	performance	measures	for another	sub recipient

,	repeat	the	process.		If	you	would	like	to	continue	to	the **Summary	Tab** to	validate	your	performance	measures,	click **Next**
. **8. Validating	Performance	Measures**  You	will	not	be	able	to	submit	your	application	without	first	validating	your performance	measures.		The **Summary	Tab** allows	you	to	review	all	of	the	measures and	targets that	you	selected.  You	can	select	to	print	the	performance	measures	by	clicking	either **Print	PDF	of Table**  or **Print	All	Performance	Measures**
.  If	you	need	to	edit	a	measure,	click **Edit	Performance	Measures** which	will	take you	back	to	the	Performance	Measures	Tab.  Once	your	performance	measures	are	complete,	click **Validate	Performance Measures**  to	include	them	in	your	application.