SOCIAL	INNOVATION	FUND	(SIF)	PAY	FOR	SUCCESS	PILOT PROGRAM

APPLICATION	INSTRUCTIONS

OMB Control #: 3045-0160 Expiration Date: 12/31/2014
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IMPORTANT	NOTICE

These	application	instructions	conform	to	the	Corporation	for	National	and	Community	Service’s	online	grant	

application	system,	eGrants.	All	funding	announcements	by	the	Corporation	for	National	and	Community	

Service	(CNCS)	are	posted	on	www.nationalservice.gov and	www.grants.gov.		

Public	Burden	Statement: Public	reporting	burden	for	this	collection	of	information	is	estimated	to	average	

30 hours	per	submission,	including	reviewing	instructions,	gathering	and	maintaining	the	data	needed,	and	

completing	the	form.	Comments	on	the	burden	or	content	of	this	instrument	may	be	sent	to	the	Corporation	

for	National	and	Community	Service,	Attn:	Amy	Borgstrom,	1201	New	York	Avenue,	NW,	Washington,	D.C.	

20525.	CNCS	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	one	are	current	and	valid.	(See	5	C.F.R.	§	1320.5(b)(2)(i).)	

Privacy	Act	Notice: The	Privacy	Act	of	1974	(5	U.S.C	§	552a)	requires	that	the	following	notice	be	provided	to	

you:	The	information	requested	on	the	Social	Innovation	Fund	Pay	for	Success	Application	Instructions	is	

collected	pursuant	to	42	U.S.C.	§§	12581b - 12585	of	the	National	and	Community	Service	Act	of	1990	as	

amended,	and	42	U.S.C.	12639.	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.	Executive	Summaries	of	all	compliant	applications	received	and	

applications	of	successful	applicants	will	be	published	on	the	CNCS	website	as	part	of	ongoing	efforts	to	

increase	transparency	in	grantmaking.	This	is	described	in	more	detail	in	the	Notice	of	Federal	Funding	

Availability/Opportunity. The	information	will	not	otherwise	be	disclosed	to	entities	outside	of	the	Social	

Innovation	Fund	and	CNCS	without	prior written	permission.	Effects	of	Nondisclosure	- The	information	

requested	is	mandatory	in	order	to	receive	benefits.		

Federal	Funding	Accountability	and	Transparency	Act: Grant	recipients	will	be	required	to	report	at	

www.FSRS.gov on	all	subawards	over	$25,000	and	may	be	required	to	report	on	executive	compensation	for	

recipients	and	subrecipients.	Recipients	must	have	the	necessary	systems	in	place	to	collect	and	report	this	

information. See 2	C.F.R.	Part	170	for	more	information	and	to	determine	how	these	requirements	apply.

Universal	Identifier: Applications	must	include	a	Dun	and	Bradstreet	Data	Universal	Numbering	System	

(DUNS)	number	and	register	with	the	Central	Contractor’s	Registry	(CCR). All	grant	recipients	are	required	to	

maintain	a	valid	registration,	which	must	be	renewed	annually.
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APPLICATION	RESOURCES

Use	these	instructions	in	conjunction	with	the	Social	Innovation	Fund Pay	for	Success	

Grants	Competition	(PFS	Competition)	Notice	of	Federal	Funding	Availability	(Notice).	The	

Notice	includes	deadlines,	eligibility	requirements,	submission	requirements,	

funding	priorities	and	other	relevant	information	that	might	change	annually.

Other	resources	for	completing	your	application	including technical	assistance	conference	

calls	and	how	to submit	inquiries can	be	accessed	from	the	Social	Innovation	Fund	(SIF)

webpage	on	the	CNCS	website (http://www.nationalservice.gov/programs/socialinnovation-fund).

CREATING	AN	EGRANTS	USER	OR	ORGANIZATION	ACCOUNT

First-time	eGrants	users need	to create an	eGrants	account	by	accessing	this	link:	

https://egrants.cns.gov/espan/main/login.jsp and	selecting	Don’t	have	an	eGrants	

account?	Create	an	account.

If	you	need	help	establishing	a	new	organization	account	or	a	new	user	account	for	an	

existing	organization	account,	or	with	other	aspects	of	eGrants,	contact	the	National	Service	

Hotline	at	800-942-2677 or	via:	https://questions.nationalservice.gov/app/ask.	

If	you	are	applying	for	continuation	funding	(for	years	2	and	beyond)	of	an	existing	

SIF	grant,	please	skip	to	the	‘REQUESTING	CONTINUATION	FUNDING’	Section of	this	

document.

NEW	APPLICATIONS

To	initiate	an	application:	

 Start	a	new	grant	application:	Select	New under	the	Creating	an	Application heading	

on	your	Home	Page

 Select	a	Program	Area:	Other

 Select	a	NOFA:	Social	Innovation	Fund	Pay	for	Success	Grants	Competition	[Applicable	

year	of	funding]

Once	you	have	initiated	an	application,	it	will	be	listed	in	the	View	My	Grants/Applications

section	of	your homepage.		If	you	exit	and	then	return	to	eGrants and	wish	to	continue	

entering	or	editing	your	application,	please	open	your	saved	version	by	selecting	View	My	

Grants/Applications.		You	should	not	use	the	New button	again	as	this	will	start	a	brand	

new	application.		

APPLICATION	CONTENT

Your	application	consists	of	the	following	sections.	Please complete	each	section.	

I. Applicant	Info	
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II. Application	Info	

III. Narratives	

IV. Performance	Measures – if	required	in	the	Notice

V. Documents

VI. Budget	

VII. Review,	Authorize,	and	Submit

Information	entered	in	the	Applicant	Info,	Application	Info,	and	Budget	sections	will	

populate	the	SF	424	Face sheet of	your	application.	

I. Applicant	Info

 Under	Project	Information select	Enter	New, create a	title	for	the	proposed	project,	

and	enter the	contact	information.		

 Select	a	Project	Initiative:		Choose	the	operational	model	which	best	describes	your	

PFS	Competition application.		Please	see	the	Notice for	details.

 Select	an	individual	as	the	Project	Director,	by	choosing a	name	from	the	pull-down	

menu	or	adding a	new	contact.

Please	note	that	the	Authorized	Representative will	be	filled	in	at	the	end	of	the	

application	when	completing	the	Assurances and	Certifications	section.	(Attachment	A)

II. Application	Info

Complete	this	section	as	follows:

 Areas	affected	by	the	project:		List	only	the	largest	political	or	municipal	entities	

affected	(e.g.,	counties	and	cities).		Please	include	the	two-letter	abbreviation	with	both	

letters	capitalized	for	each	state	where	you	plan	to	operate.	Separate	each	two-letter	

state	abbreviation	with	a	comma.	For	city	or	county	information,	please	follow	each	one	

with	the	two-letter	capitalized	state	abbreviation.

 Proposed	project	start	and	end	dates.		Please	see	the	Notice for	details about	the	

project	period	to	select.

 Intergovernmental	Review	of	Federal	Programs:		Enter ‘No.’ This program	is	NOT	

subject	to	Executive	Order	12372.

 Delinquent	on	any	federal	debt:		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’,	type	

your	explanation	in	the	text	box	provided.

 State	Application	Identifier:		Enter	N/A.

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	or	imprisonment	for	not	more	than	five	(5)	years,	or	both.	

(18	USC	§	1001).
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III. Narratives

Page	Limit and	Formatting

 It	is	important	that	you	preview	the	eGrants PDF of	your	application	to	ensure	that	you	

don’t	exceed	the	page	limit of	40	pages	as	prescribed	in	the	Notice.		Reviewers	will	stop	

reading	your	application	when	they	reach	the	page	limit.

 Also,	please	note	that	bold	face,	bullets,	underlines,	charts,	diagrams,	and	tables	or	other	

types	of formatting will	not	copy	into	eGrants.

The	Notice	provides	guidance	on	how	to	submit	each	section	of	the	application	

narrative.		

A. Executive	Summary

Please	note that	executive	summaries	for	all	applications	will	be	made	public	and	

posted	to	CNCS’	website.

B. Program	Design

C. Organizational	Capability	

D. Leadership	and	Team

E. Cost	Effectiveness	and	Budget	Adequacy

The	following	three	sections	are	not	relevant	to this	application.	Please	enter	N/A	for	

not	applicable	under	these	narrative	sections.	

F. Amendment	Justification	

Enter	N/A.	This	field	is	used	when	requesting	an	amendment	to	an	awarded	grant.	

G. Clarification	Information	

Enter	N/A.	This	field	is used	to	enter	information	that	requires	clarification	in	the	postreview	period.	

H. Continuation	Changes	

Enter	N/A.	This	field	is used	to	enter	information	for your	continuation	requests.

IV. Performance	Measures

If	 Performance	 Measures	 are	 required	 in	 the	 Notice,	 follow	 the	 instructions	 in	

Attachment	B.		

V. Documents

In	addition	to	the	application	submitted	in	eGrants,	you	are	required	to	provide	
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documentation	of	match	as	described	in	section	Submitting	Match	Verification section	of	

the	Notice.	 After you	have	submitted	all	required	documentation,	change	the	status	in	

eGrants	from	the	default	“Not	Sent”	to	the	applicable	status	“Sent.”

VI. Budget	

A. Budget	Requirements

Applicants	must	submit	a	proposed	budget	for	each	of	the	three	years	of	the	project	

period	that	includes	both	federal	and	match	funding.		If	an	application	is	selected	for	

award,	CNCS	will	determine	the	final	amount	of	the	award	of	federal	funds,	and	will	

negotiate	a	final	budget.		Upon	award,	compliance	with	the	approved	budget	will	be	a	

material	term	and	condition	of	the	cooperative	agreement	with	the	grantee.

Your	proposed	budget	should	be	sufficient	to	allow	you	to	perform	the	tasks	described	

in	your	narrative for	each	year	of	the	project	and provide	a	full	explanation	of	costs	

including	their	purpose,	justification,	and	the	basis	of	your	calculations.		Reviewers	will	

consider	the	information	you	provide	in	your	budget as	part	of their	assessment	of	the	

Cost Effectiveness	and	Budget	Adequacy	criteria.	

In	eGrants,	the	preparation	of	a	detailed	budget	provides	the	data	that	creates	the	

summary	budget	and	the	budget	narrative.		The	detailed	budget	should	provide	a	full	

explanation	of	associated	costs	including	their	purpose,	justification,	and	the	basis	of	

the	calculations. eGrants	will	perform	a	limited	compliance	check	to	validate	the	budget.	

If	it	finds	any	compliance	issues	you	will	receive	a	warning	and/or	error	messages.	You	

must	resolve	all	errors	before	you	can	submit	your	budget.

As	you	prepare	your	budget:	

 Divide	project	costs	by	year	and	submit	one	for	each	year	of	the	proposed	project	

period.

 All	the	amounts	you	request	must	be	for	a	particular	purpose.	Do	not	include	

miscellaneous,	contingency,	or	other	undefined	budget	amounts.	

 A minimum	of	80%	of	federal	dollars	granted	must	be	spent	on	services	or	subgrants	provided	to	sub-recipients.

 Itemize	each	cost	and	present	the	basis	for	all	calculations	in	the	form	of	an	

equation,	identifying	the	number	of	persons	involved	with	the	event,	the	cost	per	

person	or	unit,	and/or	the	annual	salary	cost.	

 Do	not	include	fractional	amounts	(cents).	

 PFS	Competition	grantees	are	required	to	match	federal	dollars	granted	on	a	one-toone	basis.	Up	to	50%	of	the	match	can	be	provided	by	in-kind	contributions.	

Otherwise, the	match	must	be	provided	by	nonfederal	dollars.

 Because	of	the	required	one-to-one	match	for	Social	Innovation	Fund Pay	for	Success

grantees,	the	budget	must	reflect total costs	being	distributed	equally	between	the	

federal	and	grantee	shares,	but	individual	categories	do	not have	to	be	equally	

distributed.
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Programs	must	comply	with	all	applicable	federal	laws,	regulations,	and	OMB	circulars	

for	grant	management,	allowable	costs,	and	audits,	including	providing	audits	to	the	A133	clearinghouse	if	expending	over	$500,000	in	federal	funds,	as	required	in	OMB	

Circular	A-133.

Allowable	Costs

Please	refer	to	the	relevant	OMB	Circulars	for	further	guidance on	allowable	costs.	The	

OMB	circulars	are	online	at	www.whitehouse.gov/OMB/circulars,	and	have	been	

codified	in	Title	2	of	the	Code	of	Federal	Regulations	(CFR)	as	indicated	below

 A-21	- Cost	Principles	for	Educational	Institutions,	2	CFR	Part	220	

 A-87	- Cost	Principles	for	State,	Local,	and	Indian	Tribal	Governments,	2	CFR	Part	

225	

 A-122	- Cost	Principles	for	Non	Profit	Organizations,	2	CFR	Part	230	

It	is	important	to understand	that	“allowable	costs”	under	federal	awards	do	not	

necessarily	include	all	costs	that	the	organization	will	incur	in	order	to	perform	their	

awards.		For	example,	the	cost	of	raising	funds	in	order	to	meet	the	nonfederal	

share	of	the	budget	(“matching	funds”)	is not	allowable	under	the	OMB	cost	

principles.		The	cost	principles	reflect	government-wide	requirements that	one	must	

be	aware	of	when	developing	a	budget.

B. Matching	Funds

The	non-federal	share	of	the	budget	represents	the	dollar-for-dollar	cash and	in-kind

contributions matching	requirement.		Any	organization	that	receives	a	SIF award	is	

responsible	for securing	the	necessary	match.		

The	non-federal	dollar	component	of	the	match must	equal	at	least	50%	of	the	match	

and may	come	from	state,	local,	or	private	sources,	which	may	include	state	or	local	

government	agencies,	businesses,	private	philanthropic	organizations,	or	individuals.		

Federal	funds	may	not	be	used	towards	the	match	requirement.	

The	in-kind contributions component	of	this	match	may	not	exceed	50%	of	the	match	

and	must be fully described, valued and publicized in the sub-recipient selection process. 

Third party, in-kind contributions means the value of non-cash contributions provided by 

non-Federal third parties. Third party in-kind contributions may be in the form of equipment, 

supplies and other expendable property, and the value of goods and services directly

benefiting and specifically identifiable to the project or program, or the monetary value of 

time contributed by professional and technical personnel and other skilled labor. The 

contributions or services provided must be a strategic, integral and necessary part of a funded 

project for which the grantee or sub-recipient would otherwise have to pay. The value of the 

services must be determined by what the TA provider or Transaction Coordinator normally

charges for the services or, if fees are not charged, at the amount the service costs the 

organization, such as costs for staff time, required travel, office space, allocation of indirect 

expenses, etc.
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The	total	non-federal	share	of	the	budget	must	equal	or	exceed	the	federal	share	of	the	

budget	(this	implements	the	dollar-for-dollar	match	requirement).		However,	there	is	no	

requirement	that	the	non-federal	share	of	the	budget	“mirror”	or	be	allocated	on	the	

same	basis	as	the	federal	share	of	the	budget.		

C. Budget	Line	Items

Section	I.	Program	Costs

 Project	Personnel	Expenses

List	each	staff	position	separately	with	a	brief	statement	of	responsibilities,	

salary, and	the	percentage	of	staff	time	that	will	apply	to	the	grant.	Each	staff	

person’s	role	listed	in	the	budget	must	be	described	in	the	application	narrative	

and	each	staff	person	mentioned	in	the	narrative	must	be	listed	in	the	budget	as	

either	CNCS	or	Grantee	share.		

 Personnel	Fringe	Benefits

Include	costs	of	benefit(s)	for the	project	staff.		Identify	the	types	of	fringe	

benefits	to	be	covered	and	the	costs	of	benefit(s)	for	each	staff	position.	

Allowable	fringe	benefits	typically	include	FICA,	Worker’s	Compensation,	

Retirement,	SUTA,	Health	and	Life	Insurance,	IRA,	and	401K.	You	may	provide	a	

calculation	for	total	benefits	as	a	percentage	of	the	salaries	to	which	they	apply	

or	list	each	benefit	as	a	separate	item.	If	a	fringe	benefit	amount	is	over	30%,	

please	list	covered	items	separately	and	justify the	high	cost.	Holidays,	leave,	and	

other	similar	vacation	benefits	are	not	included	in	the	fringe	benefit	rates,	but	

are	absorbed	into	the	personnel	expenses	(salary)	budget	line	item.

 Staff	Travel

Describe	the	purpose	for	which	project staff	will	travel.	Allowable costs are	

transportation,	lodging,	subsistence,	and	other	related	expenses.		Provide	a	

calculation	that	includes	itemized	costs	for	airfare,	transportation,	lodging,	per	diem,	

and	other	travel-related	expenses	multiplied	by	the	number	of	trips/staff.	Where	

applicable,	identify	the	current	standard	reimbursement	rate(s)	of	the	organization	

for	mileage,	daily	per	diem,	and	similar	supporting	information.	Reimbursement	

should	not	exceed	the	federal	mileage	rate	unless it	is	a	result	of	applicant	policy	and	

it	is	justified	in	the	budget	narrative.	Only	domestic	travel	is	allowable.		Include	costs	

for	key project	staff	including	representatives	of the	project’s	partners	to	attend	a

convening of	Pay	for	Success	Pilot	grantees.

Example of	budget	detail	required:	The	project	lead will	conduct	a	monitoring	visit:	

1 person X	$750	airfare	+	$50	ground	transportation	+	$150 lodging +	$35	per	diem

X		two	days =	$1,170	for	Monitoring.

 Equipment

Equipment	is	defined	as	tangible,	non-expendable	personal	property	having	a	useful	

life	of	more	than	one	year	AND an	acquisition	cost	of	$5,000	or	more	per	unit

(including	accessories,	attachments,	and	modifications).		If	applicable,	show	the	unit	

cost	and number	of	units	you	are	requesting.	Provide	a	brief	justification	for	the	
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purchase	of	the	equipment	under	Item/Purpose.		You	might	be	asked	to	provide	

further	explanation	of	equipment	costs	that	exceed	10%	of	the	total	CNCS	funds	

requested.		Any	items	that	do	not	meet	this	definition	should	be	entered	under	

Supplies.				

 Supplies

Include	the	funds	for	the	purchase	of	consumable	supplies	and	materials	that	do not	

fit	the	definition	above.		Applicants	must	individually	list	any	single	item	costing	

$1,000	(one	thousand)	or	more. Applicants should	provide	the	calculation	for	cost	

determinations.	

 Contractual	and	Consultant	Services

Include	costs	for	consultants	related	to	the	project’s	operations,	except	training

or	evaluation	consultants	who	should	be	listed in	those	sections.		Where	

applicable,	indicate	the	daily	rate	for	consultants.	

 Training

Include	the	costs	associated with	training	of	staff	working	directly	on	the	

project, especially	training	that	specifically	enhances	staff	project	

implementation	and	professional	skills.	If	using	a	consultant(s)	for	training,	

indicate	the	estimated	daily	rate.

 Evaluation

Include	costs	for	project	evaluation	activities,	such	as	the	use	of	evaluation	

consultants,	the	purchase	of	instrumentation	and	other	costs	specifically	for	

this	activity.		Indicate	daily	rates	of	consultants,	where	applicable.	

 Other	Costs

Subgrants - Please	enter	all	subgrant	costs	in	a	line	titled,	“Subgrants.”	

Criminal	History	Checks - Please	include	a	line	titled	“Criminal	History	Checks”	and	

enter	the	costs	for	criminal	history	background	checks	for	all	employees	or	other	

individuals	who	receive	a	salary,	stipend, or	similar	payment	from	the	grant	(CNCS	

or	non-CNCS	share).		Please	note	that	criminal	history	checks	are	required	at	both	

the	intermediary	and	subgrantee	levels.		

Other	allowable	costs	in	this	section	may	include	office	space	rental,	utilities,	

and	telephone	and	Internet	expenses	that	directly	involve	program	staff	and	are	

not	part	of	the	organization’s	indirect	cost/admin	cost.		If	shared	with	other	

projects	or	activities,	you	must	prorate	the	costs	equitably.		List	each	item	and	

provide	a	justification	in	the	budget.

 Administrative	Costs

Administrative	costs	are	general	or	centralized	expenses	of	the	overall	

administration	of	an	organization	and	do	not	include	particular	project	costs.	As	

prescribed	in	the	Notice,	this	category	may	not	exceed	20%	of	the	budget.	These
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costs	may	include	administrative	staff	positions,	rent,	IT	costs,	etc.	

 If	you	have	a	federally	approved	indirect	cost	(IDC)	rate	you	must use	it	unless	

authorized	by	CNCS	to	use	another	method.		Specify	the	Cost	Type	for	which	your	

organization	has	current	documentation	on	file,	i.e.,	Provisional,	Predetermined,	

Fixed,	or	Final	indirect	cost	rate.		Supply	your	approved	IDC	rate	(percentage).		It	

is	at	your	discretion	whether	or	not	to	use	your	entire	IDC	rate	to	calculate

administrative	costs.		If	you	choose	to	claim	a	lower	rate,	please	include	this	rate	

under	the	Rate	Claimed	field.

 If	you	do	not	have	an	IDC,	administrative	costs	should	be	entered	as	direct	

expenses.

		

 Source	of	Matching	Funds

Describe	the	grantee	match	contribution	by	entering	a	brief description,	the	amount,	

the	match	classification	(Cash,	In-kind,	or	Not	Available)	and	Match	Source	

(State/Local,	Private,	Other	or	Not	Available)	for	your	entire	match.	Define	any	

acronyms	the	first	time	they	are	used.		Each	source	should	be	entered	as	a	separate	

line	item.	E.g.	if	you	receive	support	from	two	separate	foundations,	enter	each	one	

on	a	separate	line.

Note:	You	will	be	prevented	from	validating	your	budget	in	eGrants	if	you	do not	meet	the	

dollar-for-dollar match.		You	will	receive	an	error	message	that	states,	“Grantee	share	must	

be	greater	than	or	equal	to	CNCS	share.”

VII. Review,	Authorize,	and	Submit

eGrants	requires	that	you	review	and	verify	your	entire	application	before	submitting by	

completing	the	following steps:

 Review

 Authorize

 Assurances

 Certifications

 Verify

 Submit

Read	the	Authorization,	Assurances,	and	Certifications	carefully	(Attachment	A).	The	

person who	authorizes	the	application	must	be	the	applicant’s	Authorized	Representative	

or	his/her	designee	and	must	have	an	active	eGrants	account	to	sign	these	documents	

electronically.	An	Authorized	Representative	is	the	person	in	your	organization	authorized	

to	accept	and	commit	funds	on	behalf	of	the	organization.	A	copy	of	the	governing	body’s	

authorization	for	this	official	representative	to	sign	must	be	on	file	in	the	applicant’s	office.

Be	sure	to	check	your	entire	application	to	make	sure	that	there	are	no	errors	before	

submitting	it.	eGrants will	also	generate	a	list	of	errors	if	there	are	sections	that	need	to	be	

corrected	prior	to	submission	when	you	verify	the	application.	If	someone	else	is	acting	in	

the	role	of	the	applicant’s	authorized	representative,	that	person	must	log	into	his/her	
11

eGrants	account	to	proceed	with	Authorize	and	Submit.	After	signing	off	on	the	

Authorization,	Assurances,	and	Certifications,	his/her	name	will	override	any	previous	

signatory	that	may	appear	and	show	on	the	application	as	the	Authorized	Representative.

Note:	Anyone	within	your	organization	who	will	be	entering	information	in	the	

application	at	any	point	during	application	preparation	and	submission	in	the	eGrants	

system	must	have	their	own	eGrants	account.	Individuals	may	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.”
i

ATTACHMENT A:	Assurances	&	Certifications

ASSURANCES

As the duly authorized representative of the applicant, I assure, to the best of my knowledge and belief,

that the applicant:

 Has the legal authority to apply for federal assistance, and the institutional, managerial, and

financial capability (including funds sufficient to pay the non-federal share of project costs) to

ensure proper planning, management, and completion of the project described in this application.

 Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the 

state, through any authorized representative, access to and the right to examine all records, books,

papers, or documents related to the award; and will establish a proper accounting system in

accordance with generally accepted accounting standards or agency directives.

 Will establish safeguards to prohibit employees from using their position for a purpose that

constitutes or presents the appearance of personal or organizational conflict of interest, or personal

gain.

 Will initiate and complete the work within the applicable time frame after receipt of approval of the 

awarding agency.

 Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to

prescribed standards for merit systems for programs funded under one of the nineteen statutes or

regulations specified in Appendix A of OPM’s Standards for a Merit System of Personnel

Administration (5 CFR 900, Subpart F).

 Will comply with all federal statutes relating to nondiscrimination. These include but are not limited

to: Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis 

of race, color, or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20

U.S.C. 1681-1683, and 1685-1686). which prohibits discrimination on the basis of sex; (c) Section

504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on

the basis of disability (d) The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107),

which prohibits discrimination on the basis of age; (e) The Drug Abuse Office and Treatment Act of

1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) The 

Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970

(P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism;

(g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290dd-3 and 290ee-3),

as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the

Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the 

sale, rental or financing of housing; (i) any other nondiscrimination provisions in the National and

Community Service Act of 1990, as amended; and (j) the requirements of any other nondiscrimination

statute(s) which may apply to the application.

 Will comply, or has already complied, with the requirements of Titles II and III of the Uniform

Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which

provide for fair and equitable treatment of persons displaced or whose property is acquired as a 

result of federal or federally assisted programs. These requirements apply to all interests in real

property acquired for project purposes regardless of federal participation in purchases.
ii

 Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which

limit the political activities of employees whose principal employment activities are funded in

whole or in part with Federal funds.

 Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C 276a and 276a77), the Copeland Act (40 U.S.C 276c and 18 U.S.C. 874), and the Contract Work Hours and

Safety Standards Act (40 U.S.C. 327-333), regarding labor standards for Federally assisted

construction sub-agreements.

 Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the

Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires the recipients in a special flood

hazard area to participate in the program and to purchase flood insurance if the total cost of

insurable construction and acquisition is $10,000 or more.

 Will comply with environmental standards which may be prescribed pursuant to the following: (a)

institution of environmental quality control measures under the National Environmental Policy

Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities 

pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood

hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the 

approved state management program developed under the Coastal Zone Management Act of 1972

(16 U.S.C 1451 et seq.); (f) conformity of federal actions to State (Clean Air) Implementation

Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g)

protection of underground sources of drinking water under the Safe Drinking Water Act of 1974,

as amended (P.L. 93-523); and (h) protection of endangered species under the Endangered

Species Act of 1973, as amended (P.L. 93-205).

 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C 1271 et seq.) related to

protecting components or potential components of the national wild and scenic rivers system.

 Will assist the awarding agency in assuring compliance with Section 106 of the National Historic

Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of

historic properties), and the Archaeological and Historic Preservation Act of 1974 (16U.S.C. 469a-l et

seq.).

 Will comply with P.L. 93-348 regarding the protection of human subjects involved in research,

development, and related activities supported by this award of assistance.

 Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C.

2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for

research, teaching, or other activities supported by this award of assistance.

 Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801 et seq.)

which prohibits the use of lead based paint in construction or rehabilitation of residence structures.

 Will cause to be performed the required financial and compliance audits in accordance with the Single 

Audit Act of 1984, as amended, and OMB Circular A-133, Audits of States, Local Governments, and

Non-Profit Organizations.

 Will comply with all applicable requirements of all other Federal laws, executive orders,

regulations, application guidelines, and policies governing this program.

 Will comply with the pilot program on Contractor employee whistleblower protections 
iii

established at 41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for 

Fiscal Year 2013 (Pub. L. 112-239).

 This grant and employees working on this grant will be subject to the whistleblower rights 

and remedies in the pilot program.

 Under this pilot program, an employee of a grantee may not be discharged, demoted, or 

otherwise discriminated against as a reprisal for disclosing information that the employee 

reasonably believes is evidence of gross mismanagement of a Federal contract or grant, a 

gross waste of Federal funds, an abuse of authority (an arbitrary and capricious exercise of 

authority that is inconsistent with the mission of CNCS or the successful performance of a 

contract or grant of CNCS) relating to a Federal contract or grant, a substantial and 

specific danger to public health or safety, or a violation of law, rule, or regulation related 

to a Federal contract (including the competition for or negotiation of a contract) or grant.

 The Grantee shall inform its employees in writing, in the predominant language of the 

workforce or organization, of employee whistleblower rights and protections under 41 

U.S.C. 4712, as described above.
CERTIFICATIONS

Certification – Debarment, Suspension, and Other Responsibility Matters

This certification is required by the government-wide regulations implementing Executive Order 12549,

Debarment and Suspension, 2 CFR Part 180, Section 180.335, What information must I provide before

entering into a covered transaction with a Federal agency?

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief,

that neither the applicant nor its principals:

 Is presently excluded or disqualified;

 Has been convicted within the preceding three years of any of the offenses listed in § 

180.800(a) or had a civil judgment rendered against it for one of those offenses within that

time period;

 Is presently indicted for or otherwise criminally or civilly charged by a governmental entity

(Federal, State, or local) with commission or any of the offenses listed in § 180.800(a); or

 Has had one or more public transactions (Federal, State, or local) terminated within the

preceding three years for cause or default.

Definitions

The terms “debarment”, “suspension”, “excluded”, “disqualified”, “ineligible”, “participant”, “person”,

“principal”, and “voluntarily excluded” as used in this document have the meanings set out in 2 CFR Part

180, subpart I, “Definitions.” A transaction shall be considered a “covered transaction” if it meets the 

definition in 2 CFR part 180 subpart B, “Covered Transactions.”

Assurance requirement for subgrant agreements

You agree by submitting this proposal that if we approve your application you shall not knowingly enter 

into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or

voluntarily excluded from participation in this covered transaction, unless authorized by us.

Assurance inclusion in subgrant agreements

You agree by submitting this proposal that you will obtain an assurance from prospective participants in

all lower tier covered transactions and in all solicitations for lower tier covered transactions that the 

participants are not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction.

Assurance of subgrant principals

You may rely upon an assurance of a prospective participant in a lower-tier covered transaction that is not

debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless you know

that the assurance is erroneous. You may decide the method and frequency by which you determine the 

eligibility of your principals. You may, but are not required to, check the List of Parties Excluded from

Federal Procurement and Nonprocurement Programs.

Non-assurance in subgrant agreements

If you knowingly enter into a lower tier covered transaction with a person who is suspended, debarred,

ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies 

available to the federal government, we may terminate this transaction for cause or default.

Certification – Drug Free Workplace

This certification is required by the Corporation’s regulations implementing sections 5150-5160 of the 
Drug-Free Workplace Act of 1988 (P.L. 100-690), 2 CFR Parts 182 and 2245. The regulations require 

certification by grantees, prior to award, that they will make a good faith effort, on a continuing basis,

to maintain a drug-free workplace. The certification set out below is a material representation of fact

upon which reliance will be placed when the agency determines to award the grant. False certification

or violation of the certification may be grounds for suspension of payments, suspension or termination

of grants, or government-wide suspension or debarment (see 2 CFR Part 180, Subparts G and H).

As the duly authorized representative of the grantee, I certify, to the best of my knowledge and

belief, that the grantee will provide a drug-free workplace by:

A. Publishing a drug-free workplace statement that:

a. Notifies employees that the unlawful manufacture, distribution, dispensing, possession, or use 

of a controlled substance is prohibited in the grantee’s workplace;

b. Specifies the actions that the grantee will take against employees for violating that

prohibition; and

c. Informs employees that, as a condition of employment under any award, each employee

will abide by the terms of the statement and notify the grantee in writing if the employee 

is convicted for a violation of a criminal drug statute occurring in the workplace within

five days of the conviction;

B. Requiring that a copy of the statement described in paragraph (A) be given to each employee

who will be engaged in the performance of any Federal award;

C. Establishing a drug-free awareness program to inform employees about:

a. The dangers of drug abuse in the workplace;

b. The grantee’s policy of maintaining a drug-free workplace;

c. Any available drug counseling, rehabilitation, and employee assistance programs; and

d. The penalties that the grantee may impose upon them for drug abuse violations occurring

in the workplace;

D. Providing us, as well as any other Federal agency on whose award the convicted employee was

working, with written notification within 10 calendar days of learning that an employee has 

been convicted of a drug violation in the workplace;

E. Taking one of the following actions within 30 calendar days of learning that an employee has 

been convicted of a drug violation in the workplace:

a. Taking appropriate personnel action against the employee, up to and including termination; or

b. Requiring that the employee participate satisfactorily in a drug abuse assistance or

rehabilitation program approved for these purposes by a Federal, State, or local health,

law enforcement, or other appropriate agency;

F. Making a good faith effort to continue to maintain a drug-free workplace through

implementation of paragraphs (A) through (E).

Certification - Lobbying Activities

As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of the 

applicant, I certify, to the best of my knowledge and belief, that:

 No funds received from CNCS have been or will be paid, by or on behalf of the applicant, to

any person or agent acting for the applicant, related to activity designed to influence the
enactment of legislation, appropriations, administrative action, proposed or pending before the 

Congress or any State government, State legislature or local legislature or legislative body.

 If any funds other than federal appropriated funds have been paid or will be paid to any person

for influencing or attempting to influence an officer or employee of any agency, a member of

Congress, an officer or employee of Congress, or an employee of a member of Congress in

connection with this federal contract, grant, loan, or cooperative agreement, the applicant will

submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its 

instructions;

 The applicant will require that the language of this certification be included in the award

documents for all subcontracts at all tiers (including subcontracts, subgrants, and contracts 

under grants, loans and cooperative agreements) and that all subrecipients will certify and

disclose accordingly.

Erroneous certification or assurance

The assurances and certifications are material representations of fact upon which we rely in determining

whether to enter into this transaction. If we later determine that you knowingly submitted an erroneous 

certification or assurance, in addition to other remedies available to the federal government, we may

terminate this transaction for cause or default.

Notice of error in certification or assurance

You must provide immediate written notice to us if at any time you learn that a certification or assurance 

was erroneous when submitted or has become erroneous because of changed circumstances.

Prudent person standard

Nothing contained in the aforementioned may be construed to require establishment of a system of

records in order to render in good faith the assurances and certifications required. Your knowledge and

information is not required to exceed that which is normally possessed by a prudent person in the

ordinary course of business dealings.
ATTACHMENT B:	Instructions	for	Creating	Performance	

Measures	in	eGrants

In	the	Performance	Measures	module	of	eGrants	you	will	create	performance	measures;	set	

targets	and	describe	data	collection	plans	for	your	performance	measures;	identify	

interventions	associated	with	your	program;	and	identify	performance	measures	for	

subgrantees	(as	applicable)

A. Accessing	the	Performance	Measures	Home	Page	

You	can	either	access	the	Performance	Measures	Module	after	completing	the	

Documents	section	of	your	application	or	directly	by	clicking	on	Performance	

Measures on	the	left	side	of	your	screen.

 To	begin	entering	performance	measures,	click	the	Begin button	on	the	Home	Page.		

 As	you	proceed	through	the	module,	the	Home	Page	will	summarize	your	work	

and	provide	links	to	edit	the	parts	of	the	module	you	have	completed.		You	may	

also	navigate	sections	of	the	module	using	the	tab	feature	at	the	top	of	each	page.

 Once	you	have	started	the	module,	clicking	Continue	Working will	return	you	to	

the	tab	you	were	on	when	you	last	closed	the	module.	

 To	edit	a	performance	measure,	click	the	Edit button.		

 To	delete	a	measure,	click	Delete.		

 To	create	a	new	performance	measure,	click	the	Add	New	Performance	Measure

button.

B. Creating	Performance	Measures	

On	the	Performance	Measures	Tab,	you	can	create	performance	measures	for	all	the	

grant	activities	you	intend	to	measure.		Please	note	that	there	are	mandatory	measures	

for	which	you	must	set	targets	and	report.		There	are	additional	measures	that	you	will	

select	as	they	pertain	to	your	program.				

1. Select Applicant	Type: Grantee.		

2. Select Applicant	Name:	Your	organization’s	name.

3. Enter	a Problem	Statement:	In	2-3	sentences,	briefly	describe	the	problem	that	you	

propose	to	address	through	your	SIF	grant	activities.

4. Select Targets	for	Mandatory	Performance	Measures

 Enter	a	baseline	and	target	number	for	mandatory	SIF	performance	measures.

 For	each	measure,	select	and	describe	the	instrument(s)	you	will	use	to	measure	

the	appropriate	output	or	outcome.		Instruments	are	specific	tools	used	to	collect	

information	such	as	a	behavior	checklist,	attitude	questionnaire,	attendance	

sheet,	or	interview	protocol.		Include	the	title	of	the	instrument(s),	a	brief	

description	of	what	it	measures	and	how	it	will	be	administered,	and	details	

about	its	reliability	and	validity	if	applicable.
5. Add	Additional	Performance	Measures

Select	additional	measures	if	they	are	applicable	to	your	program.		Consult	the	SIF	

Performance	Measures	Definitions	guidance	to	determine	which	performance	

measures	are	appropriate	for	your	program.		

 Select	a	focus	area	and	relevant	outputs	and/or	outcomes.		Enter	a	baseline	and	

target	number	for	each	measure.		

 For	each	measure,	select	and	describe	the	instrument(s)	you	will	use	to	measure	

your	output	or	outcome.		

 To	create	additional	measures,	select	Add	Another	FA	End	Outcome (FA=Focus	

Area)	and	select	desired	focus	areas,	outputs,	and	outcomes,	as	appropriate.

6. Identify	Interventions

Select	the	interventions	that	you	will	carry	out	to	address	the	problem	identified	in	

the	application.		Only	interventions	that	correspond	with	the	focus	area(s)	you	

selected	will	appear.

 Select	all	interventions	that	are	a	part	of	your	program	design.		

 Click	Add	User	Intervention to	add	and	describe	any	intervention	not	listed.	

7. Saving	Performance	Measures

 After	entering	all	information,	select,	Complete	PM.		This	will	return	you	to	the	

Home	Page.		

 If	you	are	an	existing	SIF	grantee	and	wish	to	create	performance	measures	for	

another	subgrantee,	repeat	the	process.		If	you	would	like	to	continue	to	the	

Summary	Tab to	validate	your	performance	measures,	click	Next.	

8. Validating	Performance	Measures

You	will	not	be	able	to	submit	your	application	without	first	validating	your	

performance	measures.		The	Summary	Tab allows	you	to	review	all	of	the	measures	

and	targets	that	you	selected.		

 You	can	select	to	print	the	performance	measures	by	clicking	either	Print	PDF	of	

Table or	Print	All	Performance	Measures.

 If	you	need	to	edit	a	measure,	click	Edit	Performance	Measures which	will	take	

you	back	to	the	Performance	Measures	Tab.

 Once	your	performance	measures	are	complete,	click	Validate	Performance	

Measures to	include	them	in	your	application.