5166 Federal Register / Vol. 69, No. 22 / Tuesday, February 3, 2004 / Notices 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

[Program Announcement No. FV03–2004] 

Family Violence Prevention and 

Services Program

AGENCY: Family and Youth Services 

Bureau, Administration on Children, 

Youth and Families (ACYF) and the 

Office of Community Services (OCS), 

Administration for Children and 

Families (ACF), Department of Health 

and Human Services (HHS).

ACTION: Notice of the availability of 

funds to State domestic violence 

coalitions for grants to carry out family 

violence intervention and prevention 

activities. 

SUMMARY: This instruction governs the 

proposed award of fiscal year (FY) 2004 

formula grants under the Family 

Violence Prevention and Services Act 

(FVPSA) to private non-profit State 

domestic violence coalitions. The 

purpose of these grants is to assist in the 

conduct of activities to promote 

domestic violence intervention and 

prevention and to increase public 

awareness of domestic violence issues. 

This announcement sets forth the 

application requirements, the 

application process, and other 

administrative and fiscal requirements 

for grants in fiscal year (FY) 2004.

DATES: Applications for FY 2004 State 

domestic violence coalition grant 

awards meeting the criteria specified in 

this instruction must be received no 

later than February 20, 2003.

ADDRESSES: Applications should be sent 

to, Family and Youth Services Bureau, 

Administration for Children, Youth, and 

Families, Administration for Children 

and Families, Attention: William D. 

Riley, 330 C Street, SW., Room 2117, 

Washington, DC, 20447.

FOR FURTHER INFORMATION CONTACT:

William D. Riley at (202) 401–5529 or email at WRiley@acf.hhs.gov, or Sunni 

Knight at (202) 401–5319 or e-mail at 

GKnight@acf.hhs.gov.

SUPPLEMENTARY INFORMATION: This 

notice for family violence prevention 

and services grants to State domestic 

violence coalitions serves two purposes. 

The first is to confirm a Federal 

commitment to reducing family and 

intimate partner violence and the 

second purpose is to urge States, 

localities, cities, and the private sector 

to become involved in State and local 

planning towards an integrated service 

delivery approach. 

Annual State Domestic Violence 

Coalition Grantee Conference 

The annual grantee conference is a 

training and technical assistance 

activity. Attendance at these activities is 

mandatory. Family Violence Prevention 

and Services Act (FVPSA) funds may 

also be used to support attendance and 

participation. A subsequent Program 

Instruction will advise State Coalition 

administrators of the date, time, and 

location of their grantee conference. 

Client Confidentiality 

FVPSA programs must establish or 

implement policies and protocols for 

maintaining the safety and 

confidentiality of the adult victims and 

their children of domestic violence, 

sexual assault, and stalking. It is 

essential that the confidentiality of 

individuals receiving FVPSA services be 

protected. Consequently, when 

providing statistical data on program 

activities, individual identifiers of client 

records will not be used (section 

303(a)(2)(E)). 

Stop Family Violence Postal Stamp 

The U.S. Postal Service was directed 

by the ‘‘Stamp Out Domestic Violence 

Act of 2001’’ (the Act), Pub. L. 107–67, 

to make available a ‘‘semipostal’’ stamp 

to provide funding for domestic 

violence programs. Funds raised in 

connection with sales of the stamp, less 

reasonable costs, will be transferred to 

the U.S. Department of Health and 

Human Services in accordance with the 

Act for support of services to children 

and youth affected by domestic 

violence. It is projected that initial 

revenues will be received during the 

third quarter of FY 2004. Subsequent to 

the receipt of the stamp proceeds, a 

program announcement will be issued 

providing guidance and information on 

the process and requirements for awards 

to programs providing services to 

children and youth. 

State Coalition Grant Application 

Requirements 

This section includes application 

requirements for family violence 

prevention and services grants for state 

domestic violence coalitions and is 

organized as follows:

Application Requirements 

A. Legislative Authority 

B. Background 

C. Eligibility 

D. Funds Available 

E. Expenditure Period 

F. Reporting Requirements 

G. Application Requirements 

H. Paperwork Reduction Act 

I. Executive Order 12372 

J. Certifications

A. Legislative Authority 

Title III of the Child Abuse 

Amendments of 1984, (Pub. L. 98–457, 

42 U.S.C. 10401, et seq.) is entitled the 

‘‘Family Violence Prevention and 

Services Act’’ (the Act). The Act was 

first implemented in FY 1986, was 

reauthorized and amended in 1992 by 

Public Law 102–295, was amended and 

reauthorized for fiscal years 1996 

through 2000 by Public Law 103–322, 

the Violence Crime Control and Law 

Enforcement Act of 1994 by Public Law 

104–235, the Child Abuse Prevention 

and Treatment Act Amendment of 1996, 

and in 2000 by the Victims of 

Trafficking and Violence Protection Act 

(Pub. L. 106–386, 10/28/2000). The Act 

was most recently amended by the 

‘‘Keeping Children and Families Safe 

Act of 2003’’ (Pub. L.108–36). 

B. Background 

Section 311 of the Act authorizes the 

Secretary to award grants to statewide 

private non-profit State domestic 

violence coalitions to conduct activities 

to promote domestic violence 

intervention and prevention and to 

increase public awareness of domestic 

violence issues. 

C. Eligibility 

To be eligible for grants under this 

program announcement, an organization 

shall be a statewide private non-profit 

domestic violence coalition meeting the 

following criteria: 

(1) The membership of the coalition 

includes representatives from a majority 

of the programs for victims of domestic 

violence operating within the State (a 

State domestic violence coalition may 

include representatives of Indian Tribes 

and Tribal organizations as defined in 

the Indian Self-Determination and 

Education Assistance Act); 

(2) The Board membership of the 

coalition is representative of such 

programs; 

(3) The purpose of the coalition is to 

provide services, community education, 

and technical assistance to domestic 

violence programs in order to establish 

and maintain shelter and related 

services for victims of domestic violence 

and their children; and 

(4) In the application submitted by the 

coalition for the grant, the coalition 

provides assurances satisfactory to the 

Secretary that the coalition: 

(A) Has actively sought and 

encouraged the participation of law 

enforcement agencies and other legal or 

judicial entities in the preparation of the 

application; and 

(B) will actively seek and encourage 

the participation of such entities in the 

Federal Register / Vol. 69, No. 22 / Tuesday, February 3, 2004 / Notices 5167

activities carried out with the grant 

(section 311(5)(A)). 

Additional Information on Eligibility 

All applications must have a Dun and 

Bradstreet Number (DUNS). A DUNS 

number will be required for every 

application for a new or renewal/

continuation of an award under 

formula, entitlement and block grant 

programs. A DUNS number may be 

acquired at no cost by calling the 

dedicated toll-free DUNS number 

request line at 1–866–705–5711 or a 

number may be requested on-line at 

http://www.dnb.com.

Private, non-profit organizations are 

encouraged to submit with their 

applications the survey located under 

‘‘Grant Related Documents and Forms’’

titled ‘‘Survey for Private, Non-Profit 

Grant Applicants.’’ The forms are 

located on the web at http://

www.acf.hhs.gov/programs/ofs/

forms.htm.

D. Funds Available 

The Department will make ten 

percent of the Family Violence 

Prevention and Services Act 

appropriation available for grants to 

State domestic violence coalitions. One 

grant each will be available for the State 

domestic violence coalitions of the 50 

states, the Commonwealth of Puerto 

Rico, and the District of Columbia. The 

Coalitions of the U.S. Territories (Guam, 

U.S. Virgin Islands, Northern Mariana 

Islands, American Samoa, and Trust 

Territory of the Pacific Islands) are also 

eligible for domestic violence coalition 

grant awards. 

E. Expenditure Period 

The FVPSA funds may be used for 

expenditures after October 1 of each 

fiscal year for which they are granted 

and will be available for expenditure 

through September 30 of the following 

fiscal year, i.e., FY 2004 funds may be 

used for expenditures from October 1, 

2003 through September 30, 2005. 

Funds will be available for obligation 

through October 1, 2004. 

F. Reporting Requirements 

The State domestic violence coalition 

grantee must submit an annual report of 

activities describing the coordination, 

training and technical assistance, needs 

assessment, and comprehensive 

planning activities carried out. 

Additionally, the coalition must report 

on the public information and education 

services provided; the activities 

conducted in conjunction with judicial 

and law enforcement agencies; the 

actions conducted in conjunction with 

other agencies such as the state child 

welfare agency; and any other activities 

undertaken under this grant award. The 

annual report also must provide an 

assessment of the effectiveness of the 

grant-supported activities. 

The annual report is due 90 days after 

the end of the fiscal year in which the 

grant is awarded, i.e., December 30. The 

final program report is due 90 days after 

the end of the two-year expenditure 

period. 

The State domestic violence coalition 

grantees must also submit an annual 

financial report, Standard form 269(SF–

269). A financial report is due 90 days 

after the end of the fiscal year in which 

the grant is awarded.

G. Application Requirements 

The State domestic violence coalition 

application must be signed by the 

Executive Director of the Coalition or 

the official designated as responsible for 

the administration of the grant. The 

application must contain the following 

information: 

We have cited each requirement to the 

specific section of the law. 

1. A description of the process and 

anticipated outcomes of utilizing these 

federal funds to work with local 

domestic violence programs and 

providers of direct services to encourage 

appropriate responses to domestic 

violence within the State, including—

Training and technical assistance for 

local programs and managers working 

the field: 

(a) Planning and conducting State 

needs assessments and planning for 

comprehensive services; 

(b) Serving as an information 

clearinghouse and resource center for 

the State; and 

(c) Collaborating with other 

governmental systems that affect 

battered women (section 311(a)(1)). 

2. A description of the public 

education campaign regarding domestic 

violence to be conducted by the 

coalition through the use of public 

service announcements and informative 

materials that are designed for print 

media; billboards; public transit 

advertising; electronic broadcast media; 

and other forms of information 

dissemination that inform the public 

about domestic violence, including 

information aimed at underserved 

racial, ethnic or language-minority 

populations (Section 311(a)(4)). 

3. The anticipated outcomes and a 

description of planned grant activities to 

be conducted in conjunction with 

judicial and law enforcement agencies 

concerning appropriate responses to 

domestic violence cases and an 

examination of related issues. 

4. The anticipated outcomes and a 

description of planned grant activities to 

be conducted in conjunction with 

Family Law Judges, Criminal Court 

Judges, Child Protective Services 

agencies, Child Welfare agencies, 

Family Preservation and Support 

Service agencies, and children’s 

advocates to develop appropriate 

responses to child custody and 

visitation issues in domestic violence 

cases and in cases where domestic 

violence and child abuse are both 

present. The anticipated outcomes and 

a description of other activities in 

support of the general purpose of 

furthering domestic violence 

intervention and prevention (section 

311(a)). 

5. The following documentation will 

certify the status of the domestic 

violence coalition and must be included 

in the grant application: 

(a) A description of the procedures 

developed between the State domestic 

violence agency and the Statewide 

coalition that allow for implementation 

of the following cooperative activities: 

(i) the participation of the State 

domestic violence coalition in the 

planning and monitoring of the 

distribution of grants and grant funds 

provided in the State (section 311(a)(5); 

and 

(ii) the participation of the State 

domestic violence coalition in 

compliance activities regarding the 

State’s family violence prevention and 

services program grantees (section 303 

(a)(C)). 

(b) Unless already on file at HHS, a 

copy of a currently valid 501(c)(3) 

certification letter from the Internal 

Revenue Service stating private nonprofit status; or a copy of the applicant’s 

listing in the Internal Revenue’s 

Services (IRS) most recent list of taxexempt organizations described in 

section 501(c)(3) of the IRS code; or 

(c) A copy of the articles of 

incorporation bearing the seal of the 

State in which the corporation or 

association is domiciled; 

(d) A current list of the organizations 

operating programs for victims of 

domestic violence programs in the State 

and the applicant coalition’s current 

membership list by organization; 

(e) A list of the applicant coalition’s 

current Board of Directors, with each 

individual’s organizational affiliation 

and the Chairperson identified; 

(f) A copy of the resume of any 

coalition or contractual staff to be 

supported by funds from this grant and/

or a statement of requirements for staff 

or consultants to be hired under this 

grant; and 

5168 Federal Register / Vol. 69, No. 22 / Tuesday, February 3, 2004 / Notices 

(g) A budget narrative which clearly 

describes the planned expenditure of 

funds under this grant. 

6. Required Documentation and 

Assurances (included in the application 

as an appendix). 

(a) The applicant coalition must 

provide documentation in the form of 

support letters, memoranda of 

agreement, or jointly signed statements, 

that the coalition: 

(i) Has actively sought and 

encouraged the participation of law 

enforcement agencies and other legal or 

judicial organizations in the preparation 

of the grant application (section 

311(b)(4)(A)); and

(ii) Will actively seek and encourage 

the participation of such organizations 

in grant funded activities (section 

311(b)(4)(B)). 

(b) The applicant coalition must 

provide a signed statement that the 

coalition will not use grant funds, 

directly or indirectly, to influence the 

issuance, amendment, or revocation of 

any executive order or similar legal 

document by any Federal, State or local 

agency, or to undertake to influence the 

passage or defeat of any legislation by 

the Congress, or any State or local 

legislative body, or State proposals by 

initiative petition, except that the 

representatives of the State Domestic 

Violence Coalition may testify or make 

other appropriate communications 

except: 

(c) When formally requested to do so 

by a legislative body, a committee, or a 

member of such organization (section 

311(d)(1)); or in connection with 

legislation or appropriations directly 

affecting the activities of the State 

domestic violence coalition or any 

member of the coalition (section 

311(d)(2)). 

The applicant coalition must provide 

a signed statement that the State 

domestic violence coalition will 

prohibit discrimination on the basis of 

age, handicap, sex, race, color, national 

origin or religion (section 307). 

Additional Forms: Private, non-profit 

organizations may submit with their 

applications the additional survey 

located under ‘‘Grant Related 

Documents and Forms’’ titled ‘‘Survey 

for Private, Non-Profit Grant 

Applicants’’ at http://www.acf.hhs.gov/

programs/ofs/form.htm.

H. Paperwork Reduction Act 

This program announcement contains 

information collection requirements in 

sections (F) and (G). We estimate that all 

of the information requirements for this 

program will take each grantee 

approximately 6 hours to complete. As 

there are 53 projected grantees, the total 

number of hours annually will be 318. 

In accordance with the Act, the 

application requirements contained in 

this notice have been approved by OMB 

under control number 0970–0062. 

I. Executive Order 12372 

This program is covered under 

Executive Order 12372, 

‘‘Intergovernmental Review of Federal 

Programs’’ for State plan consolidation 

and simplification only—45 CFR 

100.12. The review and comment 

provisions of the Executive Order and 

Part 100 do not apply. 

J. Certifications 

Applicants must comply with the 

required certifications found at the 

Appendices: 

1. The Anti-Lobbying Certification 

and Disclosure Form must be signed 

and submitted with the application. If 

applicable, a Standard Form LLL, which 

discloses lobbying payments must be 

signed and submitted. 

2. Certification Regarding Debarment:

The signature on the application by a 

coalition official responsible for the 

administration of the program attests to 

the applicant’s intent to comply with 

the Debarment Certification. The 

Debarment Certification must be signed 

and submitted with the application. 

3. Certification Regarding 

Environmental Tobacco Smoke: The 

signature on the application by a 

coalition official certifies that the 

applicant will comply with the 

requirements of the Pro-Children Act of 

1994 (Act). The applicant further agrees 

that it will require the language of this 

certification be included in any 

standards which contain provisions for 

children’s Services and that all grantees 

shall certify accordingly. 

4. Certification Regarding Drug-Free 

Workplace Requirements: The signature 

on the application by a coalition official 

attests to the applicant’s intent to 

comply with the Drug-Free Workplace 

requirements. The Drug Free Workplace 

Certification does not have to be 

returned with the application.

(Catalog of Federal Domestic Assistance 

Number 93.591, Family Violence Prevention 

and Services: Grants to State Domestic 

Violence Coalitions)

Dated: January 24, 2004. 

Clarence Carter, 

Director, Office of Community Services, 

Administration for Children and Families.

Appendices: Required Certifications: 

Anti-Lobbying and Disclosure; 

Regarding Debarment; 

Regarding Environmental Tobacco Smoke; 

and 

Drug-Free Workplace.

Appendix A 

Certification Regarding Lobbying 

Certification for Contracts, Grants, Loans, 

and Cooperative Agreements 

The undersigned certifies, to the best of his 

or her knowledge and belief, that: 

(1) No Federal appropriated funds have 

been paid or will be paid, by or on behalf of 

the undersigned, to any person for 

influencing or attempting to influence an 

officer or employee of an agency, a Member 

of Congress, an officer or employee of 

Congress, or an employee of a Member of 

Congress in connection with the awarding of 

any Federal contract, the making of any 

Federal grant, the making of any Federal 

loan, the entering into of any cooperative 

agreement, and the extension, continuation, 

renewal, amendment, or modification of any 

Federal contract, grant, loan, or cooperative 

agreement. 

(2) If any funds other than Federal 

appropriated funds have been paid or will be 

paid to any person for influencing or 

attempting to influence an officer or 

employee of any agency, a Member of 

Congress, an officer or employee of Congress, 

or an employee of a Member of Congress in 

connection with this Federal contract, grant, 

loan, or cooperative agreement, the 

undersigned shall complete and submit 

Standard Form-LLL, ‘‘Disclosure Form to 

Report Lobbying,’’ in accordance with its 

instructions. 

(3) The undersigned shall require that the 

language of this certification be included in 

the award documents for all subawards at all 

tiers (including subcontracts, subgrants, and 

contracts under grants, loans, and 

cooperative agreements) and that all 

subrecipients shall certify and disclose 

accordingly. This certification is a material 

representation of fact upon which reliance 

was placed when this transaction was made 

or entered into. Submission of this 

certification is a prerequisite for making or 

entering into this transaction imposed by 

section 1352, title 31, U.S. Code. Any person 

who fails to file the required certification 

shall be subject to a civil penalty of not less 

than $10,000 and not more than $100,000 for 

each such failure. 

Statement for Loan Guarantees and Loan 

Insurance 

The undersigned states, to the best of his 

or her knowledge and belief, that: 

If any funds have been paid or will be paid 

to any person for influencing or attempting 

to influence an officer or employee of any 

agency, a Member of Congress, an officer or 

employee of Congress, or an employee of a 

Member of Congress in connection with this 

commitment providing for the United States 

to insure or guarantee a loan, the 

undersigned shall complete and submit 

Standard Form-LLL, ‘‘Disclosure Form to 

Report Lobbying,’’ in accordance with its 

instructions. Submission of this statement is 

a prerequisite for making or entering into this 

transaction imposed by section 1352, title 31, 

U.S. Code. Any person who fails to file the 

required statement shall be subject to a civil 

penalty of not less than $10,000 and not more 

than $100,000 for each such failure.

Federal Register / Vol. 69, No. 22 / Tuesday, February 3, 2004 / Notices 5169

lllllllllllllllllllll

Signature

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Title 

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Organization

Appendix B 

Certification Regarding Debarment, 

Suspension and Other Responsibility 

Matters 

Certification Regarding Debarment, 

Suspension, and Other Responsibility 

Matters—Primary Covered Transactions 

Instructions for Certification 

1. By signing and submitting this proposal, 

the prospective primary participant is 

providing the certification set out below. 

2. The inability of a person to provide the 

certification required below will not 

necessarily result in denial of participation in 

this covered transaction. The prospective 

participant shall submit an explanation of 

why it cannot provide the certification set 

out below. The certification or explanation 

will be considered in connection with the 

department or agency’s determination 

whether to enter into this transaction. 

However, failure of the prospective primary 

participant to furnish a certification or an 

explanation shall disqualify such person 

from participation in this transaction. 

3. The certification in this clause is a 

material representation of fact upon which 

reliance was placed when the department or 

agency determined to enter into this 

transaction. If it is later determined that the 

prospective primary participant knowingly 

rendered an erroneous certification, in 

addition to other remedies available to the 

Federal Government, the department or 

agency may terminate this transaction for 

cause or default. 

4. The prospective primary participant 

shall provide immediate written notice to the 

department or agency to which this proposal 

is submitted if at any time the prospective 

primary participant learns that its 

certification was erroneous when submitted 

or has become erroneous by reason of 

changed circumstances. 

5. The terms covered transaction, debarred, 

suspended, ineligible, lower tier covered 

transaction, participant, person, primary 

covered transaction, principal, proposal, and 

voluntarily excluded, as used in this clause, 

have the meanings set out in the Definitions 

and Coverage sections of the rules 

implementing Executive Order 12549. You 

may contact the department or agency to 

which this proposal is being submitted for 

assistance in obtaining a copy of those 

regulations. 

6. The prospective primary participant 

agrees by submitting this proposal that, 

should the proposed covered transaction be 

entered into, it shall not knowingly enter into 

any lower tier covered tranaction with a 

person who is proposed for debarement 

under 48 CFR part 9, subpart 9.4, debarred, 

suspended, declared ineligible, or voluntarily 

excluded from participation in this covered 

transaction, unless authorized by the 

department or agency entering into this 

transaction. 

7. The prospective primary participant 

further agrees by submitting this proposal 

that it will include the clause title 

‘‘Certification Regarding Debarment, 

Suspension, Ineligibility and Voluntary 

Exclusion-Lower Tier Covered Transaction,’’

provided by the department or agency 

entering into this covered transaction, 

without modification, in all lower tier 

covered transactions and in all solicitations 

for lower tier covered transactions. 

8. A participant in a covered transaction 

may rely upon a certification of a prospective 

participant in a lower tier covered 

transaction that it is not proposed for 

debarment under 48 CFR part 9, subpart 9.4, 

debarred, suspended, ineligible, or 

voluntarily excluded from the covered 

transaction, unless it knows that the 

certification is erroneous. A participant may 

decide the method and frequency by which 

it determines the eligibility of its principals. 

Each participant may, but is not requied to, 

check the List of Parties Excluded from 

Federal Procurement and Nonprocurement 

Programs. 

9. Nothing contained in the foregoing shall 

be construed to require establishment of a 

system of records in order to render in good 

faith the certification required by this clause. 

The knowledge and information of a 

participant is not required to exceed that 

which is normally possessed by a prudent 

person in the ordinary course of business 

dealings. 

10. Except for transactions authorized 

under paragraph 6 of these instructions, if a 

participant in a covered transaction 

knowingly enters into a lower tier covered 

transaction with a person who is proposed 

for debarment under 48 CFR part 9, subpart 

9.4, suspended, debarred, ineligible, or 

voluntarily excluded from participation in 

this transaction, in addition to other 

remedies available to the Federal 

Government, the department or agency may 

terminate this transaction for cause or 

default. 

Certification Regarding Debarment, 

Suspension, and Other Responsibility 

Matters—Primary Covered Transactions 

(1) The prospective primary participant 

certifies to the best of its knowledge and 

belief, that it and its principals: 

(a) Are not presently debarred, suspended, 

proposed for debarment, declared ineligible, 

or voluntarily excluded by any Federal 

department or agency; 

(b) Have not within a three-year period 

preceding this proposal been convicted of or 

had a civil judgment rendered against them 

for commission of fraud or a criminal offense 

in connection with obtaining, attempting to 

obtain, or performing a public (Federal, State 

or local) transaction or contract under a 

public transaction; violation of Federal or 

State antitrust statutes or commission of 

embezzlement, theft, forgery, bribery, 

falsification or destruction of records, making 

false statements, or receiving stolen property; 

(c) Are not presently indicted for or 

otherwise criminally or civilly charged by a 

governmental entity (Federal, State or local) 

with commission of any of the offenses 

enumerated in paragraph (1)(b) of this 

certification; and 

(d) Have not within a three-year period 

preceding this application/proposal had one 

or more public transactions (Federal, State or 

local) terminated for cause or default. 

(2) Where the prospective primary 

participant is unable to certify to any of the 

statements in this certification, such 

prospective participant shall attach an 

explanation to this proposal.

Certification Regarding Debarment, 

Suspension, Ineligibility and Voluntary 

Exclusion—Lower Tier Covered Transactions 

Instructions for Certification 

1. By signing and submitting this proposal, 

the prospective lower tier participant is 

providing the certification set out below. 

2. The certification in this clause is a 

material representation of fact upon which 

reliance was placed when this transaction 

was entered into. If it is later determined that 

the prospective lower tier participant 

knowingly rendered an erroneous 

certification, in addition to other remedies 

available to the Federal Government, the 

department or agency with which this 

transaction originated may pursue available 

remedies, including suspension and/or 

debarment. 

3. The prospective lower tier participant 

shall provide immediate written notice to the 

person to which this proposal is submitted if 

at any time the prospective lower tier 

participant learns that its certification was 

erroneous when submitted or had become 

erroneous by reason of changed 

circumstances. 

4. The terms covered transaction, debarred, 

suspended, ineligible, lower tier covered 

transaction, participant, person, primary 

covered transaction, principal, proposal, and 

voluntarily excluded, as used in this clause, 

have the meaning set out in the Definitions 

and Coverage sections of rules implementing 

Executive Order 12549. You may contact the 

person to which this proposal is submitted 

for assistance in obtaining a copy of those 

regulations. 

5. The prospective lower tier participant 

agrees by submitting this proposal that, 

[[Page 33043]] should the proposed covered 

transaction be entered into, it shall not 

knowingly enter into any lower tier covered 

transaction with a person who is proposed 

for debarment under 48 CFR part 9, subpart 

9.4, debarred, suspended, declared ineligible, 

or voluntarily excluded from participation in 

this covered transaction, unless authorized 

by the department or agency with which this 

transaction originated. 

6. The prospective lower tier participant 

further agrees by submitting this proposal 

that it will include this clause titled 

‘‘Certification Regarding Debarment, 

Suspension, Ineligibility and Voluntary 

Exclusion—Lower Tier Covered 

Transaction,’’ without modification, in all 

lower tier covered transactions and in all 

solicitations for lower tier covered 

transactions. 

7. A participant in a covered transaction 

may rely upon a certification of a prospective 

participant in a lower tier covered 

transaction that it is not proposed for 

debarment under 48 CFR part 9, subpart 9.4, 

debarred, suspended, ineligible, or 

5170 Federal Register / Vol. 69, No. 22 / Tuesday, February 3, 2004 / Notices 

voluntarily excluded from covered 

transactions, unless it knows that the 

certification is erroneous. A participant may 

decide the method and frequency by which 

it determines the eligibility of its principals. 

Each participant may, but is not required to, 

check the List of Parties Excluded from 

Federal Procurement and Nonprocurement 

Programs. 

8. Nothing contained in the foregoing shall 

be construed to require establishment of a 

system of records in order to render in good 

faith the certification required by this clause. 

The knowledge and information of a 

participant is not required to exceed that 

which is normally possessed by a prudent 

person in the ordinary course of business 

dealings. 

9. Except for transactions authorized under 

paragraph 5 of these instructions, if a 

participant in a covered transaction 

knowingly enters into a lower tier covered 

transaction with a person who is proposed 

for debarment under 48 CFR part 9, subpart 

9.4, suspended, debarred, ineligible, or 

voluntarily excluded from participation in 

this transaction, in addition to other 

remedies available to the Federal 

Government, the department or agency with 

which this transaction originated may pursue 

available remedies, including suspension 

and/or debarment. 

Certification Regarding Debarment, 

Suspension, Ineligibility and Voluntary 

Exclusion—Lower Tier Covered Transactions 

(1) The prospective lower tier participant 

certifies, by submission of this proposal, that 

neither it nor its principals is presently 

debarred, suspended, proposed for 

debarment, declared ineligible, or voluntarily 

excluded from participation in this 

transaction by any Federal department or 

agency. 

(2) Where the prospective lower tier 

participant is unable to certify to any of the 

statements in this certification, such 

prospective participant shall attach an 

explanation to this proposal.

Certification Regarding Environmental 

Tobacco Smoke 

Public Law 103227, Part C Environmental 

Tobacco Smoke, also known as the Pro 

Children Act of 1994 (Act), requires that 

smoking not be permitted in any portion of 

any indoor routinely owned or leased or 

contracted for by an entity and used 

routinely or regularly for provision of health, 

day care, education, or library services to 

children under the age of 18, if the services 

are funded by Federal programs either 

directly or through State or local 

governments, by Federal grant, contract, loan, 

or loan guarantee. The law does not apply to 

children’s services provided in private 

residences, facilities funded solely by 

Medicare or Medicaid funds, and portions of 

facilities used for inpatient drug or alcohol 

treatment. Failure to comply with the 

provisions of the law may result in the 

imposition of a civil monetary penalty of up 

to $1000 per day and/or the imposition of an 

administrative compliance order on the 

responsible entity. By signing and submitting 

this application the applicant/grantee 

certifies that it will comply with the 

requirements of the Act. 

The applicant/grantee further agrees that it 

will require the language of this certification 

be included in any subawards which contain 

provisions for the children’s services and that 

all subgrantees shall certify accordingly.

Appendix D 

Certification Regarding Drug-Free 

Workplace Requirements 

The certification is required by the 

regulations implementing the Drug-Free 

Workplace Act of 1988: 45 CFR part 76, 

subpart F, sections 76.630(c) and (d)(2) and 

76.645(a)(1) and (b) provide that a Federal 

agency may designate a central receipt point 

for STATE-WIDE AND STATE AGENCYWIDE certifications, and for notification of 

criminal drug convictions. For the 

Department of Health and Human Services, 

the central point is: Division of Grants 

Management and Oversight, Office of 

Management and Acquisition, Department of 

Health and Human Services, Room 517–D, 

200 Independence Avenue, SW Washington, 

DC 20201. 

Certification Regarding Drug-Free Workplace 

Requirements (Instructions for Certification) 

1. By signing and/or submitting this 

application or grant agreement, the grantee is 

providing the certification set out below. 

2. The certification set out below is a 

material representation of fact upon which 

reliance is placed when the agency awards 

the grant. If it is later determined that the 

grantee knowingly rendered a false 

certification, or otherwise violates the 

requirements of the Drug-Free Workplace 

Act, the agency, in addition to any other 

remedies available to the Federal 

Government, may take action authorized 

under the Drug-Free Workplace Act. 

3. For grantees other than individuals, 

Alternate I applies. 

4. For grantees who are individuals, 

Alternate II applies. 

5. Workplaces under grants, for grantees 

other than individuals, need not be identified 

on the certification. If known, they may be 

identified in the grant application. If the 

grantee does not identify the workplaces at 

the time of application, or upon award, if 

there is no application, the grantee must keep 

the identity of the workplace(s) on file in its 

office and make the information available for 

Federal inspection. Failure to identify all 

known workplaces constitutes a violation of 

the grantee’s drug-free workplace 

requirements. 

6. Workplace identifications must include 

the actual address of buildings (or parts of 

buildings) or other sites where work under 

the grant takes place. Categorical descriptions 

may be used (e.g., all vehicles of a mass 

transit authority or State highway department 

while in operation, State employees in each 

local unemployment office, performers in 

concert halls or radio studios). 

7. If the workplace identified to the agency 

changes during the performance of the grant, 

the grantee shall inform the agency of the 

change(s), if it previously identified the 

workplaces in question (see paragraph five).

8. Definitions of terms in the 

Nonprocurement Suspension and Debarment 

common rule and Drug-Free Workplace 

common rule apply to this certification. 

Grantees’ attention is called, in particular, to 

the following definitions from these rules: 

Controlled substance means a controlled 

substance in Schedules I through V of the 

Controlled Substances Act (21 U.S.C. 812) 

and as further defined by regulation (21 CFR 

1308.11 through 1308.15); 

Conviction means a finding of guilt 

(including a plea of nolo contendere) or 

imposition of sentence, or both, by any 

judicial body charged with the responsibility 

to determine violations of the Federal or 

State criminal drug statutes; 

Criminal drug statute means a Federal or 

non-Federal criminal statute involving the 

manufacture, distribution, dispensing, use, or 

possession of any controlled substance; 

Employee means the employee of a grantee 

directly engaged in the performance of work 

under a grant, including: (i) All direct charge 

employees; (ii) All indirect charge employees 

unless their impact or involvement is 

insignificant to the performance of the grant; 

and, (iii) Temporary personnel and 

consultants who are directly engaged in the 

performance of work under the grant and 

who are on the grantee’s payroll. This 

definition does not include workers not on 

the payroll of the grantee (e.g., volunteers, 

even if used to meet a matching requirement; 

consultants or independent contractors not 

on the grantee’s payroll; or employees of 

subrecipients or subcontractors in covered 

workplaces). 

Certification Regarding Drug-Free Workplace 

Requirements 

Alternate I. (Grantees Other Than 

Individuals) 

The grantee certifies that it will or will 

continue to provide a drug-free workplace by: 

(a) Publishing a statement notifying 

employees that the unlawful manufacture, 

distribution, dispensing, possession, or use of 

a controlled substance is prohibited in the 

grantee’s workplace and specifying the 

actions that will be taken against employees 

for violation of such prohibition; 

(b) Establishing an ongoing drug-free 

awareness program to inform employees 

about—

(1) The dangers of drug abuse in the 

workplace; 

(2) The grantee’s policy of maintaining a 

drug-free workplace; 

(3) Any available drug counseling, 

rehabilitation, and employee assistance 

programs; and 

(4) The penalties that may be imposed 

upon employees for drug abuse violations 

occurring in the workplace; 

(c) Making it a requirement that each 

employee to be engaged in the performance 

of the grant be given a copy of the statement 

required by paragraph (a); 

(d) Notifying the employee in the statement 

required by paragraph (a) that, as a condition 

of employment under the grant, the employee 

will—

(1) Abide by the terms of the statement; 

and 

(2) Notify the employer in writing of his or 

her conviction for a violation of a criminal 

Federal Register / Vol. 69, No. 22 / Tuesday, February 3, 2004 / Notices 5171

drug statute occurring in the workplace no 

later than five calendar days after such 

conviction; 

(e) Notifying the agency in writing, within 

ten calendar days after receiving notice under 

paragraph (d)(2) from an employee or 

otherwise receiving actual notice of such 

conviction. Employers of convicted 

employees must provide notice, including 

position title, to every grant officer or other 

designee on whose grant activity the 

convicted employee was working, unless the 

Federal agency has designated a central point 

for the receipt of such notices. Notice shall 

include the identification number(s) of each 

affected grant; 

(f) Taking one of the following actions, 

within 30 calendar days of receiving notice 

under paragraph (d)(2), with respect to any 

employee who is so convicted—

(1) Taking appropriate personnel action 

against such an employee, up to and 

including termination, consistent with the 

requirements of the Rehabilitation Act of 

1973, as amended; or 

(2) Requiring such employee to participate 

satisfactorily in a drug abuse assistance or 

rehabilitation program approved for such 

purposes by a Federal, State, or local health, 

law enforcement, or other appropriate 

agency; 

(g) Making a good faith effort to continue 

to maintain a drug-free workplace through 

implementation of paragraphs (a), (b), (c), (d), 

(e) and (f). 

(B) The grantee may insert in the space 

provided below the site(s) for the 

performance of work done in connection 

with the specific grant: 

Place of Performance (Street address, city, 

county, state, zip code)

lllllllllllllllllllll

lllllllllllllllllllll

Check if there are workplaces on file that are 

not identified here. 

Alternate II. (Grantees Who Are Individuals) 

(a) The grantee certifies that, as a condition 

of the grant, he or she will not engage in the 

unlawful manufacture, distribution, 

dispensing, possession, or use of a controlled 

substance in conducting any activity with the 

grant; 

(b) If convicted of a criminal drug offense 

resulting from a violation occurring during 

the conduct of any grant activity, he or she 

will report the conviction, in writing, within 

10 calendar days of the conviction, to every 

grant officer or other designee, unless the 

Federal agency designates a central point for 

the receipt of such notices. When notice is 

made to such a central point, it shall include 

the identification number(s) of each affected 

grant. 

[FR Doc. 04–2173 Filed 2–2–04; 8:45 am] 

BILLING CODE 4184–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

[Program Announcement No. FV02–2004] 

Family Violence Prevention and 

Services Program

AGENCY: Family and Youth Services 

Bureau, Administration on Children, 

Youth and Families, (ACYF) and the 

Office of Community Services (OCS), 

Administration for Children and 

Families, Department of Health and 

Human Services.

ACTION: Notice of the availability of 

funding to Native American Tribes, 

Alaskan Villages, and Tribal 

organizations for family violence 

prevention and services. 

SUMMARY: This announcement governs 

the proposed award of formula grants 

under the Family Violence Prevention 

and Services Act to Native American 

Tribes, Alaskan Villages, and Tribal 

organizations. The purpose of these 

grants is to assist Tribes in establishing, 

maintaining, and expanding programs 

and projects to prevent family violence 

and to provide immediate shelter and 

related assistance for victims of family 

violence and their dependents. 

This announcement sets forth the 

application requirements, the 

application process, and other 

administrative and fiscal requirements 

for grants in fiscal year (FY) 2004. 

*Grantees are to be mindful that 

although the expenditure period for 

grants is a two year period, an 

application is required every year to 

provide continuity in the provision of 

services. (See B. Expenditure Period).

DATES: Applications for FY 2004 Native 

American Tribes, Alaskan Villages, and 

Tribal Organizations grant awards 

meeting the criteria specified in this 

instruction should be received no later 

than February 21, 2003.

ADDRESSES: Applications should be sent 

to Family and Youth Services Bureau, 

Administration on Children, Youth and 

Families, Administration for Children 

and Families, Attn: William Riley, 330 

C Street, SW, Room 2117, Washington, 

DC 20447.

FOR FURTHER INFORMATION CONTACT:

William D. Riley at (202) 401–5529; or 

e-mail at WRiley@acf.hhs.gov, or Sunni 

Knight at (202) 401–5319 or e-mail at 

GKnight@acf.hhs.gov.

SUPPLEMENTARY INFORMATION: 

Annual Native American and Alaskan 

Native Villages Grantee Conference

The annual grantee conference is a 

training and technical assistance 

activity. Attendance at these activities is 

mandatory. Family Violence Prevention 

and Services Act (FVPSA) funds may be 

used to support attendance and 

participation. A subsequent Program 

Instruction will advise Tribal FVPSA 

administrators of the date, time, and 

location of their grantee conference. 

Client Confidentiality 

FVPSA programs must establish or 

implement policies and protocols for 

maintaining the safety and 

confidentiality of the adult victims and 

their children of domestic violence, 

sexual assault, and stalking. It is 

essential that the confidentiality of 

individuals receiving FVPSA services be 

protected. Consequently, when 

providing statistical data on program 

activities, individual identifiers of client 

records will not be used (section 

303(a)(2)(E)). 

Stop Family Violence Postal Stamp 

The U.S. Postal Service was directed 

by the ‘‘Stamp Out Domestic Violence 

Act of 2001’’ (the Act), Pub. L. 107–67, 

to make available a ‘‘semipostal’’ stamp 

to provide funding for domestic 

violence programs. Funds raised in 

connection with sales of the stamp, less 

reasonable costs, will be transferred to 

the U.S. Department of Health and 

Human Services in accordance with the 

Act for support of services to children 

and youth affected by domestic 

violence. It is projected that initial 

revenues will be received during the 

third quarter of FY 2004. Subsequent to 

the receipt of the stamp proceeds, a 

program announcement will be issued 

providing guidance and information on 

the process and requirements for awards 

to programs providing services to 

children and youth. 

The Importance of Coordination of 

Services 

The impact of family and intimate 

violence include physical injury and 

death of primary or secondary victims, 

psychological trauma, isolation from 

family and friends, harm to children 

witnessing or experiencing violence in 

homes in which the violence occurs, 

increased fear, reduced mobility and 

employability, homelessness, substance 

abuse, and a host of other health and 

related mental health consequences. 

The physical and cultural obstacles 

existing in much of Indian country 

compound the basic dynamics of 

domestic violence. Barriers such as the 

isolation of vast rural areas, the concern