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Senior Corps

GRANT APPLICATION

Volume I

RSVP (Retired and Senior Volunteer Program)

for

Competitive Applications

Non-Competitive Administrative Renewals 

Continuation Applications

DRAFT FACSIMILE OF ELECTRONIC FORMS

Form is Authorized for Local Reproduction

CNCS Form 424-NSSC OMB Control No. 3045-0035-Expiration: 06/30/2014
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TABLE OF CONTENTS

INSTRUCTIONS

I. Purpose.....................................................................................................................................................3

II. Required Sections .....................................................................................................................................4

 Part I: Facesheet Instructions (eGrants “Applicant”, “Application”, and “Funding Demographics” Sections) ....5

 Part II: Project Narratives Instructions (eGrants “Narratives” Sections)......................................................... 9

Part II Section A: Executive Summary ........................................................................................... 9

Part II Section B: Strengthening Communities. ..............................................................................11

Part II Section C: Recruitment and Development ...........................................................................12

Part II Section D: Program Management ......................................................................................12

Part II Section E: Organizational Capability ...................................................................................13

Part II Section F: Other NOFA Requirements ................................................................................13

Part III: Performance Measures and Work Plans (eGrants “Work Plan” Sections).................................. 14

Part III Section A: About Performance Measures Requirements .....................................................14

Part III Section B: About Work Plans.............................................................................................15

 Part IV: Required Documents ..................................................................................................................18

Part V: Budget Instructions (eGrants “Budget” Sections)...........................................................................20

Part V Section A: Volunteer Support Expenses .............................................................................21

Part V Section B: Volunteer Expenses .........................................................................................22

Part VI: Funding/Demographics (eGrants “Estimated Funding” Sections)...................................................22

Continuation Application Instructions...................................................................................................................23

FORMS:

Part I – Facesheet .....................................................................................................................................24

Roster of Active Volunteer Stations (Form and Instructions) .........................................................................25

APPENDICES:

eGrants Step-by-Step Instructions............................................................................................................. 28

eGrants Performance Measures Module (PMM) Step-by-Step Instructions.................................................. 60

Work Plan Development Worksheets .......................................................................................................... ?

List of Service Activities and Instruments/Tools............................................................................................ ?
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SENIOR CORPS GRANT APPLICATION: GENERAL SUBMISSION INSTRUCTIONS1

(I) Purpose: 

The Senior Corps Grant Application of the Corporation for National and Community Service (CNCS) is for 

use by prospective and existing sponsors of Senior Corps projects under the RSVP Program (RSVP), 

Foster Grandparent Program (FGP), Senior Companion Program (SCP), and Senior Demonstration 

Programs (SDP). The forms in this package conform to CNCS’s web-based electronic grants management 

system, eGrants. 

If needed, please refer to eGrants step-by-step instructions as you complete the grant application, 

located here: LINK. 

TIP for new applicants in particular: You are encouraged to review and reference these instructions as 

you read these Grant Application Instructions and use eGrants.

The Senior Corps Grant Application Consists of two volumes:

1) Volume I – Used by applicants for RSVP grants. Instructions within the grant application indicate which 

sections are required for:

(A) – Competitive Grant Application Submissions

(B) – Non-Competitive Administrative Renewals (only as applicable).

(C) – Continuation Grant Application Submissions (current grantees in the second or third years of a 

three-year grant).

2) Volume II – Used by applicants for FGP and SCP grants, including competitive grants, renewal (noncompetitive grants), and continuation grants (current grantees in the second or third year of a threeyear grant).

Instructions in this package apply to all applicants. The instructions address the types of information that 

must be included to fulfill application and grant requirements. 

New applicants must establish 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.” 

For Applicants submitting Competitive Grant Applications: Please use these Grant Application 

Instructions in conjunction with the Notice of Federal Funding Opportunity (Notice) and RSVP Program 

Regulations [45 CFR Part 2553]. The Notice includes deadlines, eligibility requirements, submission

requirements, review criteria and other information applicable to RSVP grant competitions. The Notice is 

located here: INSERT

For Applicants submitting Non-Competitive Grant Applications: The CNCS office in each state will 

provide notification instructions, including when to begin your next grant application in eGrants.

 

1 OMB No. 3045-0035. The collection of this information is authorized by the provisions of the Domestic Volunteer Service Act of 1973, as amended, 

and the National and Community Service Trust Act of 1993. This agency informs the potential persons who may respond to the collection of information 

that such persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Estimated time to 

complete this application, including time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and 

completing and reviewing the collection of information averages 13.2 hours per response (16.5 for new applicants, 15 for previous sponsors, and 5 for 

revisions). If you have any comments regarding this collection of information, send them to: Corporation for National and Community Service, Senior 

Corps, Attn: Angela Roberts, 1201 New York Avenue, W, Washington, D.C. 20525. As required by Section 504 of the Rehabilitation Act of 1973, as 

amended, this application may be available in alternative formats. Make TTD/TTY inquiries to: (202) 565-2799. Direct written inquiries to: Senior 

Corps, 1201 New York Ave. NW, 9th Floor, Washington, DC 20525. Direct telephone inquiries to: (202) 606-5000, Ext. 554.
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Prohibited Activities

For competitive applications, please refer to the Notice. 

For continuation grants, please refer to the RSVP Regulations link. 

(II) Required Sections of the Grant Application

(a) First-time Applicants for an RSVP, FGP, or SCP Grant that are applying for a competitive grant 

or current FGP or SCP grantees applying for a new multi-year renewal grant must complete all 

sections of the Grant Application:

 Part I: Facesheet (Modified Standard Form 424 NSSC) – Page 5

 Part II: Project Narratives – Pages 9-13

 Part III: Work Plans – Pages 14-15

 Part IV: Attachments: Required attachments are indicated on Page 18

 Part V: Budget (NSSC Form 424A) – Pages 20-22

 Part VI: Funding/Demographics – Page 22

 Assurances (Standard Form 424B) – Page 24

 Certifications (NSSC Form 424C) – ???

(b) Non-Competitive Continuation Applications: Years 2 and 3 of the Multi-Year Grant must 

complete the following sections:

 Part I: Facesheet (Modified Standard Form 424 NSSC) – Page 5

 Part II: Section ___: Executive Summary – Page and amend any existing information if not relevant 

or current for the upcoming grant performance period.

 Part III: Work Plans – Update work plans that have changed from initial submission to remain 

consistent with the proposed activities and performance measures Pages 14-15

 Part IV: Attachments: As specified for continuation projects on Page 18

 Part V: Budget (NSSC Form 424A) – Pages 20-22

 Part VI: Funding/Demographics – Page 22

 Other: Updates of any other sections of the application or the required attachments if significant 

changes have occurred or are anticipated during Year 2 or Year 3.

Note: Submission of a grant application does not assure receipt of a grant award.
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PART I: FACESHEET INSTRUCTIONS: eGrants “Applicant Info”, “Application Info”, and 

“Funding/Demographics” Sections

Information entered in the Applicant Info, Application Info, and Funding/Demographics sections will 

populate the SF 424 Facesheet in the eGrants system. The items below coincide to sections of the SF 

424 Facesheet. 

Please enter or update the requested information in the fields that appear. The contact person needs to 

be the individual who can best answer questions about the application. 

Item #

1. Filled in for your convenience.

2. Self-explanatory.

3. 3.a. and 3.b. are for State use only (for AmeriCorps use only – not applicable for Senior Corps)

4. Item 4.a: Leave blank

Item 4.b: If you are a current grantee applying for year 2 or 3 of an already-awarded grant, your grant 

number will automatically populate.

5. This section contains the Applicant Information. Please enter the following information:

a. The complete name of the organization that will be legally responsible for the grant. This is not the 

name of the organizational unit within the legally responsible organization. For example, indicate 

“National University” instead of “Liberal Arts Department.”

b. The name of the primary organizational unit that will undertake the assistance activity, if different from 

5.a. Using the example above, here is the place to use “Liberal Arts Department.”

c. Your organization’s complete address with the 5-digit ZIP code and the 4-digit extension. The 4-digit 

ZIP code extension is required.

d. The name and contact information of the project director or other person to contact on matters related 

to this application. 

6. Enter your Employer Identification Number (EIN) as assigned by the Internal Revenue Service.

6a. Enter your Organization’s Dun and Bradstreet Data Universal Numbering System (DUNS) number. If 

needed, the applicant organization may obtain a DUNS number by calling the request line at (866) 705-

5711 or online at http://www.dnb.com.

7. Item 7.a.: Enter the appropriate letter in the box.

Item 7.b: Consult the following list of characteristics of applicants and enter (all that apply) the 

corresponding numbers, each in a separate blank. 
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8. Check the appropriate box for type of application and enter the appropriate letter(s) in the lower boxes:

a. Check “New” if you are applying for a new competitive RSVP grant.

b. Check “Continuation” if you are a current grantee applying for your second or third year of funding.

c. Check “Amendment” if you are a grantee proposing any change in your budget, requesting a no 

cost extension, or revising your Work Plans. 

If you are proposing an Amendment to your grant, check the type of revision you are submitting.

Contact your CNCS State Office prior to creating an amendment.

a. Select “Augmentation” if you are taking an action that changes the programming of the awarded 

grant. 

b. Select “Budget Revision” if you are a Senior Corps RSVP grantee submitting a revised budget to 

incorporate a CNCS-authorized increase or CNCS-authorized decrease.

c. Select “No Cost Extension” to request an extension of the grant period, then enter the extension 

date requested in the blank following the checkbox. No-cost extensions must be requested before 

the project period ends.

d. Select “Other,” as applicable, and specify in the blank provided.

 

9. Filled in for your convenience.

10. Use the following list of CFDA (Catalog of Federal Domestic Assistance) number for RSVP:

94.01 Retired and Senior Volunteer Program (RSVP)

11. Select the appropriate link or dropdown project to:

a. Enter the title of the project. (For example, RSVP of Cabot County).

b. Enter the name of the CNCS program initiative, if any, as provided in the instructions corresponding 

to the Notice for which you are applying; otherwise, leave blank.

1. 2-year college 17. Local Government

2. 4-year college 18. National Non-profit (Multistate)

3. Area Agency on Aging 19. Other Native American Organization

4. Chamber of Commerce/Business 

Association

20. Other State Government

5. Community Action Agency/ Community 

Action Program

21.School (K-12)

6. Community College 22. Self-Incorporated Senior Corps 

Project

7. Community-Based Organization 23. Service/Civic Organization

8. Faith-based organization 24. State Commission/Alternative 

Administrative Entity

9. Governor’s Office 25. State Education Agency

10. Grant-making Entity Operating in Two or 

More States

26. Statewide Association

11. Health Department 27. Tribal Government Entity

12. Hispanic Serving College or University 28. Tribal Organization (nongovernment)

13. Historically Black College or University 

(HBCU)

29. U.S. Territory

14. Law Enforcement Agency 30. Vocational/Technical College

15. Local Affiliate of National Organization 31. Volunteer Management 

Organization

16. Local Education Agency
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12. List all of the geographic locations where the service will occur or is occurring. Please designate by the 

county or counties. Please include all counties applicable. 

For competitive grants, please also include the appropriate state and number of the grant opportunity 

from the Notice (for example: North Carolina #3).

13. Please reference Item 8 (Above) 

 “New: Enter the proposed project Start and End Dates. This is a 3-year period, also known as the 

“project period.”

 “Continuation” or “Amendment” application: Enter the dates of the approved project period.

14. Fill in the performance period. The “performance period” is the time period covered by the budget, and is 

usually defined as 12-months. If other than 12-months, the Notice or supplemental guidance will indicate 

the performance period. 

15. Estimated Funding: Enter the estimated amount requested or to be contributed during this performance 

period on the appropriate line, as shown below. The value of in-kind contributions should be included in these 

amounts, as applicable. 

(a) Federal - The total amount of Federal funds being requested in the budget. This amount is 

automatically populated based on budget sections I and II.

(b) Applicant - The total amount of the applicant share as entered in the budget. This amount is 

automatically populated based on budget sections I and II.

(c) Local - The amount of the applicant share that is coming from local sources.

(d) State - The amount of the applicant share that is coming from state sources.

(e) Other - The amount of the applicant share that is coming from other sources.

(f) Income - The amount of the applicant share that is coming from income generated by 

programmatic activities.

(g) Total - The applicant's estimate of the total funding amount for the agreement. This amount is 

automatically populated based on budget sections I and II.

16. Indicate if this application is subject to review by the state "Executive Order 12372 Process" by checking 

the box. Executive Order 12372, "Intergovernmental Review of Federal Programs," was issued with the 

desire to foster the intergovernmental partnership and strengthen federalism by relying on state and local 

processes for the coordination and review of proposed federal financial assistance and direct Federal 

development. The Order allows each state to designate an entity to perform this function. A list of these 

"Single Point of Contact" entities can be found at: http://www.whitehouse.gov/omb/grants_spoc. Contact 

the Single Point of Contact to determine whether your application is subject to the state intergovernmental 

review process.

a. If Yes, indicate the date a copy of your application was submitted to the state for review under the 

Executive Order 12372 Process

b. If No, check the appropriate box.

17. Check the appropriate box. This question applies to the applicant organization, not the person who signs 

as the authorized representative. Categories of debt include delinquent audit allowances, loans, and 

taxes. If Yes, attach an explanation.

18. Signature. Please note that this is an electronic signature that results from submitting the grant application 

in the electronic grants management system, eGrants. The person who signs this form must be the 

applicant’s authorized representative. A copy of the governing body’s authorization for this official 

representative to sign must be on file in the applicant’s office. 
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Note: Falsification or concealment of a material fact or submission of false, fictitious or fraudulent statements or 

representations to any department or agency of the United States Government may result in a fine of not more than 

$10,000 or imprisonment for not more than five (5) years, or both. (18 U.S. Code Section 1001)
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PART II: PROJECT NARRATIVES INSTRUCTIONS (eGrants “Narratives” Sections)

The purpose of the project narratives and the accompanying Work Plans (see Part IV) is for you to provide 

a project plan with a clear and compelling justification for achieving results with the requested funds. 

You may not exceed 25 double-spaced pages for the Narratives, including the Executive Summary 

and Facesheet as the pages print out from eGrants.

In the case of competitive grants, reviewers will not consider material submitted over the page limit, 

even if eGrants allows you to enter and submit text over the limit. From the Review and Submit page, print 

out your application prior to final submission to ensure it is not over the 25 page limit. This limit does not 

include the budget and performance measures. 

PART II – SECTION A. EXECUTIVE SUMMARY

Please provide a summary of your proposed project. The Executive Summary must be no longer than one 

page. 

The Executive Summary should include:

 The number of unduplicated RSVP volunteers serving or that will serve.

 The types of populations they serve or will serve, such as children, frail seniors, veterans, etc.

 The primary focus area that the project will address. 

 The volunteer service activities or what they will actually do.

 The locations of these service activities.

 The expected results or outcomes of the volunteers’ services.

 The number of stations.

 The federal funding level.

 The non-federal funding level.

You may adopt and fill in the blanks on the following template to complete your Executive Summary: “An 

estimated [fill in the number] RSVP volunteers will serve. They will [fill in service activities] through a 

network of [fill in the number of volunteer stations/placement sites] such as [fill in types of 

organizations where the volunteers serve or will serve]. The primary focus area of this project is [fill in 

CNCS Focus Area]. At the end of the 12-month performance period, [fill in the anticipated outcome(s)]. 

The CNCS federal investment of $ [fill in the annual federal grant amount or the requested amount] 

will be supplemented by $ [fill in the anticipated level of non-federal resources]. 

NOTE: CNCS will post these summaries on www.nationalservice.gov in the interest of transparency and 

open government.
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PART II – SECTION B. STRENGTHENING COMMUNITIES

The recommended number of pages for this section is: ______

Competitive grants must align with the RSVP Performance Measures Requirements. These 

requirements are listed below, and are repeated in Part III – Work Plans.

1) Performance Measures Requirements for RSVP

Your grant application must reflect the Performance Measures Requirements established for the 

RSVP program by CNCS, as listed in items A) through D) below. The performance measures are a 

required part of the work plans submitted as part of your grant application.

The unit of measure for RSVP performance measures requirements is “unduplicated RSVP 

volunteers.” “Unduplicated RSVP volunteers” means that each RSVP volunteer is only counted 

once, even if the volunteer is engaged in more than one activity. 

As noted previously, please refer to the Appendices for the list of performance measures, work 

plan development worksheets, and list of service activities.
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A) Requirement 1: A minimum of 10 percent of the unduplicated RSVP volunteers must be in work 

plans that result in outcomes. As you formulate the community needs that your volunteers will 

meet, and develop appropriate service activities to meet those needs, please ensure that this 10 

percent total is included. The 10 percent of volunteers can be consolidated in one work plan, or 

can be reflected in as many work plans as you need to accurately describe their placements and 

outcomes. The 10 percent is the minimum threshold. You may increase the required percentage. 

B) Requirement 2: At least 25 percent of the unduplicated RSVP volunteers must be placed in 

assignments that address one of the CNCS Focus Areas, which would be the Primary Focus 

Area for this grant application. You may exceed the required percentage.

The Focus Areas are:

• Education 

• Healthy Futures 

• Veterans and Military Families 

• Environmental Stewardship 

• Economic Opportunity 

• Disaster Services 

C) Requirement 3: No more than 30 percent of the unduplicated RSVP volunteers can be placed in 

the community priorities work plan.

D) Requirement 4: The remainder of the unduplicated RSVP volunteers are placed in volunteer 

activities aligned with either:

 CNCS Agency-Wide outputs and/or Complementary Program Outputs; OR 

 CNCS Agency-Wide outputs and/or Complementary Program Capacity Building outputs.

After planning for 25 percent of the unduplicated RSVP volunteers to be placed in CNCS 

primary focus areas (requirement B) and for a maximum of 30 percent of unduplicated RSVP 

volunteers to be placed in local community priorities (requirement C), the remainder must be 

placed in activities aligned with the CNCS Agency-Wide OR Complementary Program outputs.

2 – Writing Your Strengthening Communities Narrative

As you write your grant application narratives, which are found in Part II – Sections B through E of 

this application, unless otherwise noted, please limit your descriptions to at least 25 percent of 

volunteers that must be placed to meet needs in one Primary Focus Area.

As you write your narrative, please respond to the following: 

 Describe the community you serve. Provide persuasive evidence that community needs 

identified in the Primary Focus Area exist in the geographic service area and is currently 

unmet. Use demographic information, census data, or other sources as needed to present your 

case.

 Describe the ways in which RSVP volunteers and their stations are managed as a highly 

effective means to address the identified community need(s) in the Primary Focus Area.

 Describe the service activities in the Primary Focus Area that lead to National Performance 

Measure outputs or outcomes.

 Connect the following three major elements in the Primary Focus Area, so that the service 

activities address the need, and result in the anticipated outputs and/or outcomes: 
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1. the community needs identified, 

2. the service activities that will be carried out by RSVP volunteers 

3. the anticipated output(s) or outcome(s)

 Include current or planned significant activities in service to veterans and military families.

o Serving veterans and military families should be discussed as part of the Primary Focus 

Area, Other Focus Areas, or in Capacity Building. Serving veterans and military families 

does not need to be included in the Community Priorities. 

PART II – SECTION C. RECRUITMENT AND DEVELOPMENT

The recommended number of pages for this section is: ______

In this section of the narrative, please describe:

 Your plan and infrastructure to create high quality volunteer assignments with opportunities such as 

building skills, developing leadership potential, reflecting on the meaning of service, and enhancing the 

quality of the volunteers’ own lives.

 Your plan and infrastructure to ensure RSVP volunteers receive the training needed to be effective in 

their assignments.

 Your plan and infrastructure to recruit a volunteer pool reflective of the demographics of the geographic 

communities served. As applicable, include plans to recruit and place individuals of all races, 

ethnicities, and degrees of English language proficiency. 

 Your plan and infrastructure to recruit veterans and military family members as RSVP volunteers.

 Your plan and infrastructure to recruit RSVP volunteers with disabilities, including individuals with agerelated disabilities

 Your plan and infrastructure to retain and recognize the RSVP volunteers.

PART II – SECTION D. PROGRAM MANAGEMENT

The recommended number of pages for this section is: _______

In this section, describe specific plans and strategies for overall management of the RSVP project that you 

propose. Please focus your narrative on the following:

 Your plan and infrastructure to ensure management of volunteer stations in compliance with RSVP 

program regulations and applicable laws.

 Your plan and infrastructure to develop capacity to recruit and manage volunteer stations that address 

specified unmet community needs outside the Primary Focus Area.

 Your plan and infrastructure to responsibly graduate volunteer stations to meet changing community 

needs and minimize disruptions to current volunteers where possible. The plan may include reassigning 

volunteers at the station to capacity building assignments. 

 Your plan and infrastructure to assure National Performance Measure outcomes and outputs are 

measured and collected.

 Your plan and infrastructure to manage project resources, both financial and in-kind, to ensure 

accountability and efficient and effective use of available resources.
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PART II – SECTION E. ORGANIZATIONAL CAPABILITY 

Briefly describe your organization’s capability to operate the RSVP project that you propose with respect to: 

 Your plans and infrastructure to provide sound programmatic and fiscal oversight, day-to-day 

operational support and data collection, to include clearly defined internal policies.

 Descriptions of clearly defined staff positions, including how these positions will be sustained and (as 

applicable) identification of current staff assigned to the project. 

 Your organization’s track record in the Primary Focus Area, senior service, managing volunteers, and in 

measuring performance.

 Demonstrating strong organizational infrastructure, including: (1) Tangible assets such as facilities, 

equipment, and supplies; (2) Governance structure and operations, such as internal policies, 

purchasing procedures, and personnel management; (3) Role of a community participation group, such 

as an RSVP Advisory Council, to ensure input from the community; and (4) The existence of robust 

management systems and past experience managing federal grant funds. 

 Demonstrate how your organization will adequately sustain the proposed required non-federal share.

PART II – SECTION F. OTHER Notice REQUIREMENTS – REFERENCE ONLY

This section is used, as needed, to address any additional program requirements that appear in the 

published Notice or supplemental instructions. Refer to the Notice for specifics.
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PART III – Performance Measures and Work Plans: eGrants “Work Plan” Section

PART III – SECTION A. ABOUT PERFORMANCE MEASURES REQUIREMENTS

1) About RSVP Performance Measures

Performance Measures are the means by which RSVP grantees demonstrate tangible outcomes 

and results of the volunteers’ services in the community. Performance Measures include the “what” 

(indicators); the “how” (tools); and the “proof” (targets). 

A) Requirement 1: A minimum of 10 percent of the unduplicated RSVP volunteers must be 

identified in work plans that result in outcomes. As you formulate the community needs that your 

volunteers will address, along with their service activities, please ensure that this 10 percent total 

is included. The 10 percent of volunteers can be consolidated in one work plan, or can be 

reflected in as many work plans as you need to accurately describe their placements and 

outcomes. The 10 percent requirement is the minimum threshold. You may increase the required 

percentage. 

B) Requirement 2: At least 25 percent of the unduplicated RSVP volunteers must be placed in 

assignments that address one of the CNCS Focus Areas, which would be the Primary Focus 

Area for this grant application. You may increase the required percentage.

The Focus Areas are:

• Education 

• Healthy Futures 

• Veterans and Military Families 

• Environmental Stewardship 

• Economic Opportunity 

• Disaster Services 

C) Requirement 3: No more than 30 percent of the unduplicated RSVP volunteers can be placed in 

the community priorities work plan.

D) Requirement 4: The remainder of the unduplicated RSVP volunteers are placed in volunteer 

activities aligned with either:

a. CNCS Agency-Wide outputs and/or Complementary Program Outputs OR 

b. CNCS Agency-Wide outputs and/or Complementary Program Capacity Building outputs.

After planning for 25 percent of the unduplicated RSVP volunteers to be placed in CNCS primary

focus areas (requirement B) and for a maximum of 30 percent of unduplicated RSVP volunteers to 

be placed in local community priorities (requirement C), the remainder must be placed in activities 

aligned with the CNCS Agency-Wide OR Complementary Program outputs.
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PART III – SECTION B. ABOUT WORK PLANS

2) About Work Plans

 A Work Plan is a task plan with action steps to address a specified community need. In 

the grant application, these Work Plans form the basis for a proposed project plan: the 

need the volunteers will address, what they will do, what their service should accomplish for 

each 12-month performance period of the grant.

 Work Plans follow a standard format in eGrants Performance Measures Module.

 Work Plans capture the focus of the volunteers’ services in standard categories. These 

include Focus Areas and Service Activities. 

3) How many Work Plans are needed?

The number of work plans needed is determined by how you place your volunteers, and by the 

types of service activities they will undertake. 

4) How are Work Plans completed?

Data that you enter into the eGrants Performance Measures Module (PMM) are the basis for 

your work plans. As you enter data on the community need and select your outcomes, outputs, 

service activities and other information, the eGrants PMM will build your work plans for you. 

Attachment ____ consists of worksheets designed to help you plan your performance measures. 

These worksheets can help to organize how you will fit your performance measures together with 

the volunteer activities. We recommend that you use the worksheets and instructions to map out 

your work plans, and then use the completed worksheets to transfer the information into the 

eGrants PMM.

Please click here for step-by-step instructions on how to use the eGrants PMM.

5) Which sections of the Work Plans must be completed and what is the purpose of each section?

The following sections must be completed for all Work Plans with one exception. This exception is the 

one work plan that will capture all of the volunteers placed to meet “Community Priorities.” 

(a) Description of Community Need: The description of the community need must be completed for 

each output you select. This needs statement should explain the compelling need that will be 

addressed by the volunteers. When you develop your community need, be sure to:

 Describe the need in enough detail to convey its importance in the community. Use of local 

statistics can be helpful to make your case.

 Describe the consequences of the need going unmet in the community.

 Describe why RSVP volunteers can be effective resources to meet the need.

 Describe the need in a way that is clear to people unfamiliar with your community. Do not 

assume that other readers have an existing understanding.

(b) Primary Focus Area and Objective: These items must be completed by selecting the correct 

options on the pull down menus in the eGrants PMM.
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The set of Focus Areas and Related Objectives are:

Focus Area Related Objectives

Healthy Futures Aging in Place

Access to Care

Obesity and Food

Aging in Place - Respite

Education K-12 Success

School Readiness

Economic Opportunity Housing

Financial Literacy

Employment

Disaster Services Assistance Provided

Veterans and Military Families Veterans and Military Families Served

Environmental Stewardship At Risk Ecosystems

(c) Output: Outputs are the immediate results of the volunteers’ services. These are usually counts –

numbers of people served, etc. The output is selected using the pull down menu in the eGrants 

PMM.

(d) Service Activity: The service activity is the actual task (such as mentoring, providing 

transportation) that the volunteers will perform. For each output, you may select more than one 

service activity. The service activities are selected by checking the appropriate boxes in the eGrants 

PMM. For each service activity selected, the eGrants PMM will create a separate work plan.

(e) Number of Unduplicated Volunteers: This is the proposed number of volunteers who will be 

performing each service activity. Each volunteer can only be counted once when assigned to a 

service activity. The volunteer should be counted in the area where he/she will make the most 

impact – in terms of the type of service or in terms of the scope of service, such as the most 

number of hours served.
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(f) Total Number of Volunteers: The total number of volunteers engaged in the activities, if you 

were to assign all of them according to each activity, will be entered in this section. In this way, 

volunteers can be counted more than once – for example, if the same volunteer does two 

different types of activities such as meal delivery AND companionship, you can account for all 

assignments in this field.

(g) Targets: The target is the number that you anticipate achieving in the performance period 

(usually 12 months). For example, if you think your volunteers will serve 200 frail seniors over 

the course of the performance period, you would enter 200 as your target.

(h) Instrument used for Tracking Output: This is the tool that will be used for data collection. 

The Instrument is selected using the pull down menu in the eGrants PMM. 

The following is only completed for Work Plans that you select as containing outcomes.

(i) Outcome: Outcomes are the longer term or permanent change or improvement expected in 

the community due to the volunteers and their services. The outcome is selected using the pull 

down menu in the eGrants PMM. As noted in the requirement sections, a minimum of 10 

percent of your total unduplicated volunteers must be in assignments with outcomes.

(j) Instrument used for Tracking Outcome: This is the tool that will be used for data collection. 

The Instrument is selected using the pull down menu in the eGrants PMM. 

Example of how the eGrants Performance Measures Module will build work plans based 

on the information you enter:

In this example, your community need is lack of enough resources to help frail seniors, many of 

whom live on fixed incomes, particularly to help alleviate loneliness and to find affordable 

transportation to medical and other necessary appointments. RSVP volunteers can provide such 

assistance. You would describe this in the “community need” section. 

You select the “Healthy Futures” Focus Area, with the Objective of “Aging in Place”, because the 

stated need aligns with these components.

You then select one output and one instrument for the overall community need from the options 

list in the PMM. If you decide to select outcomes, you designate this, and select an outcome 

instrument as well.

Then, you start selecting service activities from the options list in the PMM. These are the 

duties/activities that the RSVP volunteers will perform – “transportation” as one service activity, 

“food delivery” as another, and “companionship” as another. 

Once you finish selecting your service activities and click to add the performance measure, the 

eGrants system will automatically generate three work plans – one for each service activity you 

selected. You will then enter your targets for each work plan that you will enter in the PMM that 

you will report against in a Progress Report. These work plans will all share the same community 

need, Focus Area and Objective, output and instrument, outcome and instrument (if selected).

6.1 Which sections of the Work Plan must be completed for the no more than 30 percent of volunteers 

placed in the category “Community Priorities”?

The requirement that no more than 30 percent of volunteers may be placed to meet “Community 

Priorities” will be consolidated into one (1) comprehensive work plan. This work plan has fewer required 

sections.

The following sections must be completed in the “Community Priorities” work plan. No other sections 

are required.
18

(a) Description of Community Need: The description should briefly state the needs that the 

volunteers will meet. If more than one need will be addressed as a community priority, each need 

should be listed. (For example: “Local community organizations need assistance to better serve 

their clients. Nursing homes need items for residents; museums needs docents to guide tours, 

senior centers need helpers for congregate meals, and libraries need help with filing and general 

clerical support. RSVP volunteers will knit lap robes for nursing home residents; serve as docents in 

our local history museum; assist congregate meal sites; and help community libraries with filing and 

mailing their newsletters.”)

(b) Output: There is one pre-determined output for the “Community Priorities” work plan – “Grantee 

met its target for community priority activity Yes/No.” This will be the only option available when 

entering the Community Priority work plan.

(c) Number of Unduplicated Volunteers: This is the proposed number of volunteers who will be 

performing each service activity. 

(d) Number of Volunteers: The total number of volunteers proposed, when counting the 

volunteers by assignment. Volunteers can be counted more than once (such as one volunteer 

serving in nursing homes and also at the library).

(e) Total Number of Volunteer Stations: The total number of placement sites or volunteer 

stations. 

PART IV. INSTRUCTIONS FOR REQUIRED SUPPLEMENTAL DOCUMENTS (eGrants “Documents” 

Section)

Documents cannot be attached in eGrants. Use eGrants to indicate the status of the document: Already on 

File at CNCS, Not Applicable, Sent, or Not Sent. For competitive applications, all items marked as Sent in 

eGrants should be sent to the address listed in the NOFO. For continuation applications, all items marked as 

Sent in eGrants should be sent to your CNCS State Office. All financial documents (items 4, 5, 6, 10, 11, 12, 

and 13) for competitive applications and continuation applications should be sent to the FFMC at:

Field Financial Management Center

The Curtis Center

601 Walnut Street

8

th Floor – Room 876 –E

Philadelphia, PA 19106

Include your eGrants application ID number and organization name with all documents.
19

REQUIRED SUPPLEMENTAL DOCUMENTS

Description of Attachment

Applicants who must submit the 

attachment as part of the 

application

New New/ 

Previous 

CNCS 

Grantee

Continuation

1. Copy of the annual assessment to assess the accomplishments 

and impact of the project.

No No Once during 

year 2 or year 

3

2. List of the sponsor’s current Board of Directors, including name, 

address, and organizational or community affiliation.

Yes Only if 

changed

Only if 

changed

3. Names and addresses of community advisory group or 

proposed advisory group members.

Yes Only if 

changed

Only if 

changed

4. Direct Deposit Forms including SF-1199A, Recipient Contact 

Form, and FFR User Form.

Yes No No

5. Financial Management Survey. Yes No No

6. Copy of Negotiated Indirect Cost Rate Agreement, if indirect 

costs are requested.

Yes Yes Yes

7. Applicant’s organizational chart showing the major components 

and the number, positions and reporting relationships of the 

proposed project staff within the sponsoring organization.

Yes Only if 

changed

Only if 

changed

8. Project Director job description. Yes Only if 

changed

Only if 

changed

9. Roster of Volunteer Stations in standard, required format (see p. 

19).

Yes Yes Yes

10. Statement of audit status that indicates whether the applicant is 

subject to A-133 Audit requirements. If yes, provide the date of 

the last audit and the date forwarded to the Audit Clearinghouse.

Yes Yes Yes

ADDITIONAL ATTACHMENTS REQUIRED OF PRIVATE NON-PROFIT APPLICANTS

In addition to the Attachments listed above under Section V. private non-profit applicants must also include the 

following:

Description of Attachment

Applicants who must submit the attachment 

as part of the application

New New/ 

Previous 

CNCS 

Grantee

Continuation

11. Aggregate annual dollar amounts of funding broken 

out by name and type. Include the name and dollar 

amount for any organizations/sources that provide at 

least 10 percent of total funding in the past budget year. 

Use standard, required format (see p.).

Yes Yes Yes

12. IRS certification of non-profit status. Yes Only if 

changed

Only if changed

13. Most recent financial statement audit or 990. Yes Yes Yes

Note: By signing the application, an official of the grantee organization certifies that any attachment not 

included has not changed from the prior submission that is on file with CNCS.
20

PART V – BUDGET INSTRUCTIONS: eGrants Budget Sections 

Refer to the eGrants Step-by-Step Instructions for entering your budget. Below are the following 

instructions for each line item of the Budget form.

For competitive applications, please refer to the NOFA which includes the elements of cost effectiveness and 

budget adequacy that will be highlighted during the competition.

(a) Multi-year applications - Complete the SF 424A Budget form requesting funds for the first annual 

budget period following the instructions below. Multi-year project approval does not guarantee that the 

application will be approved for additional funding. If we approve an application and enter into a multiyear award agreement, we will issue a Notice of Grant Award (NGA) that will provide funding only for 

the first year. You must submit a continuation application, via eGrants, for each year of the award to 

request additional funding. We will use the distribution of line item amounts proposed for the first year 

in budgeting for subsequent years, unless you submit an application for revising the budget. 

(b) Single-year applications - Complete the SF 424A Budget form for the 12-month period, following 

the instructions below. Unless otherwise instructed by an agent of the CNCS, or referenced in the 

NOFA or supplemental guidance, all grants are multi-year.

General Instructions for SF 424A Budget form Columns 1, 2, 3, and 4: 

In Column 1, enter the total project cost for that line item from all sources.

(a) In Column 2, enter the amount of CNCS funding requested for each line item and the total. 

(b) In Column 3, enter the amount of funds for the item that is expected to be covered by grantee funds 

or funds the grantee expects to receive from other sources, including cash and in-kind support.

(c) Required Non-Federal Share: Please see table below. In cases of demonstrated need, as specified 

in the respective program regulations, exceptions to these cost-sharing requirements may be 

allowed. 

Program Required Non-Federal Share

RSVP New Applicants that do not currently sponsor an RSVP project:

10% of the total project cost in Year 1, 20% in Year 2, and 30% in subsequent 

years

Current RSVP sponsors applying for a competitive grant in their current 

geographic service area:

30% of the total project cost for every year

(d) Enter any excess contributions in excess of required non-federal share in optional Column 4, 

as stipulated in Section 224 of the Domestic Volunteer Service Act, as amended. 

(e) For each Budget Line Item, please: 

 Briefly describe all amounts in Columns 2, 3, and 4.
21

PART V – SECTION A. VOLUNTEER SUPPORT SERVICES

Source of Matching Funds: Please fill in the sources of non-federal share at the beginning of eGrants 

Sections I and II.

NOTE:

For all line items, please put the total cost in Column 1 and then use Columns 2 – 4 to identify the 

source of funds as appropriate:

Line A. Project Personnel Expenses – List the title of each staff position charged to the project. 

List all positions/titles that are either funded by CNCS, grantee share, or excess resources. 

Include:

1. The position title.

2. The full-time equivalent (FTE) annual salary. 100% FTE is normally 40 hours/week. Thus, if an 

employee works half time or 20 hours/wk for the project and is paid $10,000 from project funds, 

the FTE annual salary would be $20,000.

3. The percentage of time the person will work for the project over a 12 month year (for example, if 

the employee works 10 hours per week for the project over 12 months, you would enter 25%.). 

Line B. Personnel Fringe Benefits – Enter in the appropriate column the cost of fringe benefits to 

which employees are entitled, calculated on the same percentage time indicated under line A for each 

individual. In your Budget Narrative, provide details concerning the benefits provided. (e.g., 

Retirement contributions for all staff working over 60% time, calculated at 5% of total annual salaries 

of $80,000 = $4,000).

Line C. Local Travel – Enter travel costs on the local lines, as appropriate, on the Budget form. 

Include only travel costs for staff listed under budget line A and who directly support the grant 

activities described in your application. Local travel is travel within the project service area as shown 

in item 12 of the Face Sheet. Briefly list the purpose of anticipated local travel and the basis for cost 

calculations. 

Line D. Long Distance Travel – Enter travel costs on the long distance lines, as appropriate, on the 

Budget form. Include only travel costs for staff listed under budget line A and who directly support the 

grant activities described in your application. All travel outside the service area is long distance travel. 

For long distance travel, show the purpose for each trip and break out for each the cost of 

transportation, meals and lodging, and other travel costs. 

Line E. Equipment - Enter on the Budget form the cost of equipment. Items costing less than 

$5,000 should be listed in supplies.

Line F. Supplies - List the types of supplies and their respective costs. Please itemize large items.

Line G. Contractual and Consultant Services - Enter the cost of contracts and consultants as 

appropriate. In your Narrative itemize each contract or consultant and provide a brief justification of 

the need for each. Include here all services documented in a contract, such as clerical support, 

training consultants, equipment repair and maintenance, or bookkeeping services.
22

Line H. Other Volunteer Support Costs – Briefly describe all other allowable Volunteer Support 

Expenses not included in categories A through F, such as criminal history background checks, 

training, evaluation services, recruitment expenses, and other items. Criminal history background 

checks are required for all employees or other individuals who receive a salary or similar payment 

from the grant (federal or non-federal share). 

Line I. Indirect Costs - Enter indirect charges applicable to volunteer support expenses. In your 

Narrative, describe the type of rate (provisional, predetermined, final or fixed) in effect during the 

budget period, estimated amount of the base to which the indirect rate was applied, and total indirect 

expense. A copy of the current negotiated indirect cost agreement must be in place with the cognizant 

federal agency.

SUBTOTAL BUDGET SECTION I – The subtotal will automatically be populated based on Budget 

section A. 

PART V – SECTION B. VOLUNTEER EXPENSES

Source of Matching Funds: Please fill in the sources of non-federal share at the beginning of eGrants 

Sections I and II.

Line A. Other Volunteer Costs – Enter line items in the respective categories the applicable costs 

and reimbursable expenses in columns 1, 2, 3, and 4, as appropriate. 

 RSVP allowable costs and reimbursable expenses include: Volunteer Travel, Meals, Volunteer

Recognition, and Insurance. Insurance for volunteers when on assignment is required. 

Volunteers may also be reimbursed for costs incurred while performing assignments – including 

transportation, equipment, supplies, etc. – provided such costs are described in the 

Memorandum of Understanding negotiated with the volunteer station where the volunteer is 

assigned and there are sufficient funds available to cover these expenses and meet all other 

requirements of the NGA. 

SUBTOTAL BUDGET SECTION II – The subtotal will automatically be populated based on Budget 

section B.

PART VI – FUNDING/DEMOGRAPHICS INSTRUCTIONS: Estimated Funding

Line A. Total – The sum of the totals for Sections I and II will auto-calculate from sections A and B of 

your Budget.

Line B. Federal Share – The sum of the totals for Federal funding will auto-calculate from section A 

and B of your Budget.

Line C. Applicant Share - The sum of the totals for Grantee funding will auto-calculate from section A 

and B of your Budget.

Line D. Applicant Share Breakdown – Enter the breakdown of the applicant share into the following 

sources. The sum of the source amounts must add up to Line C.

 Line E. Demographics - Enter the total number of unduplicated volunteers. 
23

CONTINUATION APPLICATION INSTRUCTIONS

Must be completed by current grantees submitting a non-competitive continuation request for year 2 

or 3 of the multi-year grant.

Contact your CNCS State Office for specific timeframes for continuation application submission.

How to Submit Your Continuation Request:

 From your eGrants home page, click Continuation/Renewal. A list of applications for your 

organization will be displayed. 

 Click Continue next to the application that you plan to update and submit for your continuation. Be 

sure to select the correct application. 

 Next you will see a list of Notice options. Your CNCS State Office will provide you with the appropriate 

NOFA to select.

 After the NOFA is selected, eGrants creates the continuation application which will include a copy of all 

information from your previously awarded application. Edit your continuation application as directed in 

the continuation request instructions below. 

 When you have completed your edits, your Authorized Representative should login with their eGrants 

account and click the SUBMIT button.

If you have questions about the content of your continuation, please contact your CNCS State Office. If you 

experience problems using eGrants, contact the eGrants Help Desk at (800) 942-2677.

What to Include in Your Continuation Request:

I. Applicant Info, Application Info and Funding/Demographics

Update only if there have been significant changes at your project or organization. 

II. Narratives

The Executive Summary should be reviewed and updated to ensure that the outcomes reflect any 

changes made in the Work Plans. All other narratives should only be updated if the information is no 

longer accurate due to project or sponsor organization changes. If the narrative information is accurate, 

leave it unchanged in the continuation application.

III. Work Plan

Information will copy from your previously awarded application into your continuation application. Work 

Plans are designed to align with the 12-month performance period. Update the Work Plans as needed to 

reflect the upcoming performance period for the continuation.

IV. Documents

Refer to the Continuation column on pages ___ and send the required documents to your CNCS State 

Office.

V. Budget

Update the budget for the upcoming year. Incorporate any changes such as a new source of non-federal 

funds, adjustments to recognition, or personnel changes. The non-federal share must increase to 20% in 

year 2 and 30% in year 3 and subsequent years.
24

PART I – FACESHEET OMB No. 3045-0035 Expiration Date ______

APPLICATION FOR FEDERAL ASSISTANCE 1.TYPE OF SUBMISSION:

Application Non-Construction

2. DATE SUBMITTED TO 

CORPORATION FOR NATIONAL 

AND COMMUNITY SERVICE 

(CNCS): 

3. a. DATE RECEIVED BY STATE: 3.b. STATE APPLICATION IDENTIFIER:

4. a. DATE RECEIVED BY CNCS: 4.b. CNCS GRANT NUMBER:

5. APPLICANT INFORMATION

LEGAL NAME: 

ORGANIZATIONAL UNIT: 

NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR 

OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS 

APPLICATION (give area codes):

ADDRESS (give street address, city, county, state and zip code): NAME: 

TELEPHONE NUMBER: ( ) -

FAX NUMBER: ( ) -

INTERNET E-MAIL ADDRESS: 

WEBSITE: 

6. EMPLOYER IDENTIFICATION 

NUMBER (EIN):

6A. DUNS Number: 7.a. TYPE OF APPLICANT: (enter appropriate letter in box) 

A. State H. Independent School District

B. County I. State Institution of Higher Learning

C. Municipal J. Private University 

D. Township K. Indian Tribe

E. Interstate L. Individual

F. Intermunicipal M.Profit Organization

G. Special District N. Private Non-Profit Organization

O. Other (specify)

7.b. CNCS APPLICANT CHARACTERISTICS 

8. TYPE OF APPLICATION (Check appropriate box):

NEW CONTINUATION

REVISION 

If Revision, enter appropriate letter(s) in box(es):

A. Increase Award: B. Decrease Award: 

 C. Increase Duration: to (enter date)

 D. Decrease Duration: to (enter date)

 E. OTHER (specify): 

9. NAME OF FEDERAL AGENCY:

Corporation for National and Community Service

10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:

 

Name of Program ___________-

__________________________________________

11. a. TITLE OF APPLICANT’S PROJECT:

12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, 

etc.): 14. PERFORMANCE PERIOD: Start Date End Date: 

 

13. PROPOSED PROJECT: START DATE: END DATE: 

15. ESTIMATED FUNDING: Check applicable box: Yr 1: Yr.2: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE

a. FEDERAL $ ORDER 12372 PROCESS?

 a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE 

b. APPLICANT $

 TO THE STATE EXECUTIVE ORDER 12372 PROCESSS 

FOR

 REVIEW ON:

c. STATE $

 DATE ___________________________________

 b. NO. PROGRAM IS NOT COVERED BY E.O. 12372

d. LOCAL $

 

 OR PROGRAM HAS NOT BEEN SELECTED BY 

STATE FOR 

 REVIEW e. OTHER $

17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?

f. TOTAL $ YES If “Yes,” attach an explanation. NO

18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, 

THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY 

WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.

a.TYPED NAME OF AUTHORIZED REPRESENTATIVE: b.TITLE: c.TELEPHONE NUMBER:

d.SIGNATURE OF AUTHORIZED REPRESENTATIVE: e.DATE SIGNED:

Modified Standard Form 424-NSSC (Rev. 3/03 to conform to the CNCS eGrants system)

-
25

ROSTER OF ACTIVE VOLUNTEER STATIONS

INSTRUCTIONS

The accompanying template in Excel corresponds to these instructions. The Volunteer Station Roster must be 

completed using the MS Excel workbook template.

The workbook template contains the following parts:

Tab 1: Instructions

Tab 2: Volunteer Station Roster template

Tab 3: Volunteer Station Types

The purpose of this form is to provide information about each active volunteer station. 

For New Applicants: The definition of “active volunteer station” is any volunteer station where you intend to 

place RSVP volunteers if the grant application is funded. If the grant application is funded, the Volunteer 

Station Roster will be updated at a later time to reflect actual volunteer placement.

The definition of “active volunteer station” is any volunteer station with which you have a MOU. Please make 

every effort to provide complete and accurate data.

For each header item with a small red triangle in the upper right corner of the cell: if you place your cursor over 

the cell and wait a few seconds (“hover”), a “pop-up” comment box, with further description, will appear.

Note that the spreadsheet will “scroll” up and down, leaving the column names and station names visible at all 

times.

Please do not change the location of each data item (e.g., moving or adding cells or columns), as this is a 

standardized form.
26

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection of information is estimated to average 5 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: Amy Borgstrom, 1201 New York Avenue, NW, Washington, D.C. 20525. The Corporation informs people 

who may respond to this collection of information that they are not required to respond to the collection of information 

unless the OMB control number and expiration date displayed on page 1 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 notice be provided to you: 

The information requested on the Senior Corps Grant Application is collected pursuant to 42 U.S.C 12592 and 12615 of 

the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act 

of 1973 as amended. Purposes 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 lawfully authorized requests. In some programs, the information may also be 

provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. 

The information may also be provided to appropriate federal agencies and Department contractors that have a need to 

know the information for the purpose of assisting the Department’s efforts to respond to a suspected or confirmed breach 

of the security or confidentiality or information maintained in this system of records, and the information disclosed is 

relevant and unnecessary for the assistance. The information will not otherwise be disclosed to entities outside of the

Corporation for National and Community Service without prior written permission. Effects of Nondisclosure - The 

information requested is mandatory in order to receive benefits. 

OMB Control Number 3045-0035

Expiration Date 6/30/2014