U.S. DEPARTMENT OF EDUCATION

OFFICE OF POSTSECONDARY EDUCATION

WASHINGTON, DC 20006-8513

Fiscal Year 2016

APPLICATION FOR GRANTS

PREDOMINANTLY BLACK INSTITUTIONS FORMULA 

GRANT PROGRAM

CFDA No. 84.031P

APPLICATION AVAILABLE DATE:

February 1, 2016

CLOSING DATES:

PHASE I: March 2, 2016

PHASE II: April 1, 2016

OMB No. 1840-0812

Expires on: 07/31/2016
2

TABLE OF CONTENTS

Dear Applicant Letter ................................................................................................. 3

Competition Highlights .............................................................................................. 5

Overview of Program ................................................................................................. 6

Requirements and Funding Rules .............................................................................. 9

Statute ........................................................................................................................ 10

Closing Date Notice ................................................................................................... 15

Instructions for Completing the Application

Part I: Formula Elements .......................................................................................... 39

Part II: Project Plan ................................................................................................... 42

 Goals and Objectives Form ...................................................................................... 45

Part III: Standard Forms, Certifications and Surveys

 Application for Federal Assistance (SF 424) ........................................................... 47

 Instructions for the SF 424 ....................................................................................... 50

 Supplemental Information Required for Department of Education ......................... 52

 Instructions for Supplement to SF 424 ..................................................................... 53

 Definitions for Supplement to SF 424 ...................................................................... 54

 ED 524 Budget Information ..................................................................................... 57

 Instructions for ED 524 ............................................................................................ 59

 GEPA ....................................................................................................................... 61

 Disclosure of Lobbying Activities SF-LLL ............................................................. 62

 Instructions for Completion of SF-LLL ................................................................... 63

 GPRA ....................................................................................................................... 64

 Application Transmittal Instructions ....................................................................... 66
3

UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF POSTSECONDARY EDUCATION

Dear Applicant:

Thank you for your interest in applying for a fiscal year (FY) 2016 grant under the 

Predominantly Black Institutions (PBI) Formula grant program. This program was 

established by the Higher Education Opportunity Act of 2008 and is authorized under 

Title III, Part A, Section 318 of the Higher Education Act of 1965, as amended (HEA). 

The purpose of the PBI program is to assist eligible institutions in expanding educational 

opportunities for their students through a program of Federal assistance. A copy of the 

statute for this program and all instructions and forms required to apply for a grant are 

included in this application booklet.

To be eligible to apply for a grant under the PBI program, institutions of higher education 

must first apply for and be designated as eligible institutions for Title III and Title V 

funding. Information about applying for designation as an eligible institution may be 

found at: http://www2.ed.gov/programs/pbihea/index.html.

Institutions must also meet the statutory definition of a PBI, and must not be receiving 

assistance under other programs in Parts A and B of Title III; Part A of Title V; or be 

authorized to receive an annual appropriation under the Act of March 2, 1867 (14 Stat. 

438; 20 U.S.C. 123).

All eligible institutions who qualify as PBIs and submit the required application materials 

in accordance with the instructions will receive a portion of the total appropriation for the 

PBI Formula grant program. Funds to eligible PBIs will be awarded based on the 

funding formula included in the program statute.

Please read carefully the Notice Inviting Applications (NIA) for New Awards for this 

program that was published in the Federal Register and is included in this application. 

The NIA includes information on the deadline for transmittal of applications and other 

program requirements. Do not follow any guidance that is in conflict with the contents of 

the NIA.

Please note that there are two deadlines for transmittal of application materials, each 

pertaining to different phases of the application process. Phase I of the application 

involves the submission of data necessary to determine statutory eligibility and apply the 

funding formula that determines the amount each eligible institution will receive. Phase 

II of the application involves the submission of the narrative project plan, abstract, and all 

standard forms, including the SF 524 Budget form and narrative. The deadlines for 

submission of Phase I and Phase II of the application are listed in the NIA.
4

Page 2 – Dear Applicant

If you have any questions or require additional information, please contact Bernadette D. 

Miles via e-mail at bernadette.miles@ed.gov or by phone at (202) 502-7616.

I appreciate your interest in the PBI program and look forward to receiving your 

application.

Sincerely,

/signed/

Donald E. Watson
5

COMPETITION HIGHLIGHTS

 The Predominantly Black Institutions (PBI) Program was established by the Higher 

Education Opportunity Act of 2008 and is authorized under Title III, Part A of the Higher 

Education Act of 1965, as amended (HEA). The PBI program makes grant awards for up 

to five years to eligible institutions to plan, develop, undertake and implement programs 

to enhance the institution’s capacity to expand higher education opportunities for lowincome and Black American students. A copy of the statute for this program and all 

instructions and forms necessary to apply for grants are included in this application 

booklet. 

 To be eligible to apply for a grant under the PBI program, institutions of higher education 

must first apply for and be designated eligible institutions for Title III and Title V 

funding. Information about applying for designation as an eligible institution may be 

found at http://www2.ed.gov/programs/pbihea/index.html. Institutions must also meet 

the program-specific eligibility requirements described in the statute. Institutions 

classified as an HBCU are not eligible to apply for this program.

 The amount allotted to each PBI under this program may not be less than $250,000. If 

the amount appropriated for this program for a fiscal year is not sufficient to pay the 

minimum allotment to eligible institutions, then the amount of the minimum allotment 

must be ratably reduced, in accordance with the statute.

 Amounts will be awarded based on a formula. All institutions who meet the statutory 

definition of a PBI and submit the required materials will receive a portion of the total 

appropriation. The amount that an eligible institution receives depends on a formula 

based on the number of Federal Pell Grant recipients, the number of graduates, and the 

number of graduates seeking a higher degree at that institution.

 The application process will have two phases. 

 In Phase 1, applicant institutions will submit the data requested in Part I of the 

application, demonstrating that they meet the program-specific eligibility 

requirements, and enabling program staff to calculate how much funding the 

institution qualifies for based on the formula contained in the statute.

 In Phase 2, Parts II and III of the application will be submitted after the 

institution is informed by the Department how much funding it will receive based on 

the data submitted by the institution in Part I. Part II includes the budget, budget 

narrative, and a project narrative of no more than 50 pages describing the project 

activities, the goals and objectives of the project, and an evaluation plan including 

performance measures. Part III of the application includes the standard forms, 

certifications and surveys.

 Deadline for Submitting Phase 1 Data: March 2, 2016

 Deadline for Submitting Phase 2 Data: April 1, 2016
6

PREDOMINANTLY BLACK INSTITUTIONS FORMULA GRANT PROGRAM

AUTHORIZING LEGISLATION

Higher Education Act of 1965 as amended (HEA), Title III, Part A, Section 318.

APPLICABLE REGULATIONS

Education Department Administrative Regulations (EDGAR), Parts 75, 77, 79, 81, 82,

84, 85, 86, 97, 98 and 99.

OVERVIEW OF PROGRAM

Purpose:

The Predominantly Black Institutions (PBI) Program makes five-year grant awards to 

eligible institutions to plan, develop, undertake and implement programs to enhance the 

institution’s capacity to serve more low- and middle-income Black American students; to 

expand higher education opportunities for eligible students by encouraging college 

preparation and student persistence in secondary school and postsecondary education; 

and to strengthen the financial ability of the institution to serve the academic needs of 

these students.

Eligibility:

To be eligible to apply for a grant under the PBI program, institutions of higher education 

must first apply for and be designated eligible institutions for Title III and Title V 

funding. Information about applying for designation as an eligible institution may be 

found at http://www2.ed.gov/programs/pbihea/index.html.

To be eligible, an institution of higher education must--

 have an enrollment of needy undergraduate students;

 have an average educational and general expenditure that is low, per full-time 

equivalent undergraduate student, in comparison with the average educational and 

general expenditure per full-time equivalent undergraduate student of institutions 

that offer similar instruction;

 have an enrollment of undergraduate students that is not less than 40 percent 

Black American students;

 be legally authorized to provide, and provide, within the State an educational 

program for which the institution of higher education awards a baccalaureate 

degree or, in the case of a junior or community college, an associate's degree;

 be accredited by a nationally recognized accrediting agency or association 

determined by the Secretary to be a reliable authority as to the quality of training 

offered or is, according to such an agency or association, making reasonable 

progress toward accreditation; 
7

 not be receiving assistance under other programs in parts A and B of Title III;

part A of title V; or be authorized to receive an annual appropriation under the 

Act of March 2, 1867 (14 Stat. 438; 20 U.S.C. 123).

 have not less than 1,000 undergraduate students;

 have not less than 50 percent of undergraduate students enrolled that are lowincome individuals or first-generation college students; and

 have not less than 50 percent of the undergraduate students enrolled in an 

educational program leading to a bachelor's or associate's degree that the eligible 

institution is licensed to award by the State in which the eligible institution is 

located.

Enrollment of Needy Students – For purposes of this part, the term “enrollment of 

needy students” means enrollment at an eligible institution with respect to which not less 

than 50 percent of the undergraduate students enrolled in an academic program leading to 

a degree—

 in the second fiscal year preceding the fiscal year for which the determination is 

made, were Federal Pell Grant recipients for such year;

 come from families that receive benefits under a means-tested Federal benefit 

program;

 attended a public or nonprofit private secondary school that--

1. is in the school district of a local educational agency that was eligible for 

assistance under part A of title I of the Elementary and Secondary Education 

Act of 1965 for any year during which the student attended such secondary 

school; and

2. for such year of attendance, was determined by the Secretary (pursuant to 

regulations and after consultation with the State educational agency of the 

State in which the school is located) to be a school in which the enrollment of 

children meeting a measure of poverty under section 1113(a)(5) of such Act 

exceeds 30 percent of the total enrollment of such school; or

 are first-generation college students and a majority of such first-generation 

college students are low-income individuals.

Low-Income Individual - For the purpose of this part, the term “low-income individual” 

means an individual from a family whose taxable income for the preceding year did not 

exceed 150 percent of an amount equal to the poverty level determined by using criteria 

of poverty established by the Bureau of the Census.

First-Generation College Student – For the purposes of this part, the term “first 

generation college student” means -

(A) an individual both of whose parents did not complete a baccalaureate degree; or

(B) in the case of any individual who regularly resided with and received support 

from one parent, an individual whose only such parent did not complete a 

baccalaureate degree.

Means-tested Federal Benefit Program - a program of the Federal Government, other 

than a program under title IV of the HEA, in which eligibility for the program's benefits, 

or the amount of such benefits, are determined on the basis of income or resources of the 

individual or family seeking the benefit.
8

Authorized Activities:

Grant funds may be used for the following activities:

 Academic instruction in disciplines in which Black Americans are 

underrepresented.

 Establishing or enhancing a program of teacher education designed to qualify 

students to teach in a public elementary school or secondary school in the State 

that must include, as part of such program, preparation for teacher certification or 

licensure.

 Establishing community outreach programs that will encourage elementary school 

and secondary school students to develop the academic skills and the interest to 

pursue postsecondary education.

 Purchase, rental, or lease of scientific or laboratory equipment for educational 

purposes, including instructional and research purposes.

 Construction, maintenance, renovation, and improvement in classrooms, libraries, 

laboratories, and other instructional facilities, including the integration of 

computer technology into institutional facilities to create smart buildings.

 Support of faculty exchanges, faculty development, and faculty fellowships to 

assist in attaining advanced degrees in the field of instruction of the faculty.

 Development and improvement of academic programs.

 Purchase of library books, periodicals, and other educational materials, including 

telecommunications program material.

 Tutoring, counseling, and student service programs designed to improve academic 

success, including innovative, customized, instruction courses designed to help 

retain students and move the students rapidly into core courses and through 

program completion, which may include remedial education and English language 

instruction.

 Education or counseling services designed to improve the financial literacy and 

economic literacy of students or the students' families.

 Funds management, administrative management, and acquisition of equipment for 

use in strengthening funds management.

 Joint use of facilities, such as laboratories and libraries.

 Establishing or improving a development office to strengthen or improve 

contributions from alumni and the private sector.

 Establishing or improving an endowment fund.

 Creating or improving facilities for Internet or other distance learning 

technologies, including purchase or rental of telecommunications technology 

equipment or services.

 Other activities proposed in the application that--

a. contribute to carrying out the purpose of the PBI Program; and

b. are approved by the Secretary as part of the review and approval of an 

application.
9

REQUIREMENTS AND FUNDING RULES

Endowment Funds:

A PBI may use not more than 20 percent of the grant funds to establish or increase an 

endowment fund at the institution. In order to be eligible to use grant funds to establish or 

increase an endowment, a PBI must provide matching funds from non-Federal sources, 

in an amount equal to or greater than the Federal funds used for the establishment or 

increase of the endowment fund. The provisions of part C of Title III apply to the 

establishment or increase of an endowment fund under the PBI program.

Construction:

Not more than 50 percent of the grant funds provided to a PBI under this program may be 

used for constructing or maintaining a classroom, library, laboratory, or other 

instructional facility.

Minimum Award:

The amount allotted to each PBI may not be less than $250,000. If the amount 

appropriated for this program for a fiscal year is not sufficient to pay the minimum 

allotment, then the amount of the minimum allotment must be ratably reduced.

Funding Formula:

Grant amounts to PBIs will be awarded according to the following formula: 

(1) Federal Pell Grants- From the amount appropriated for this program for any fiscal 

year, the Secretary must allot to each PBI a sum that bears the same ratio to onehalf of that amount as the number of Federal Pell Grant recipients in attendance at 

such institution at the end of the academic year preceding the beginning of that 

fiscal year, bears to the total number of Federal Pell Grant recipients at all such 

institutions at the end of such academic year.

(2) Graduates- From the amount appropriated for this program for any fiscal year, the 

Secretary will allot to each PBI a sum that bears the same ratio to one-fourth of that 

amount as the number of graduates for such academic year at such institution, bears 

to the total number of graduates for such academic year at all such institutions.

 (3) Graduates Seeking a Higher Degree - From the amount appropriated for this 

program for any fiscal year, the Secretary must allot to each PBI a sum that bears 

the same ratio to one-fourth of that amount as the percentage of graduates from 

such institution who are admitted to and in attendance at, not later than two years 

after graduation with an associate's degree or a baccalaureate degree, a 

baccalaureate degree-granting institution or a graduate or professional school in a 

degree program in disciplines in which Black American students are 

underrepresented, bears to the percentage of such graduates for all such institutions.
10

PREDOMINANTLY BLACK INSTITUTIONS PROGRAM 

STATUTE

SEC. 318. (NOTE: 20 USC 1059e) PREDOMINANTLY BLACK INSTITUTIONS

(a) Purpose.--It is the purpose of this section to assist Predominantly Black Institutions in 

expanding educational opportunity through a program of Federal assistance.

(b) Definitions.--In this section:

 (1) Eligible institution.--The term “eligible institution” means an institution of higher 

education that--

 (A) has an enrollment of needy undergraduate students;

(B) has an average educational and general expenditure that is low, per full-time 

equivalent undergraduate student, in comparison with the average educational and 

general expenditure per full-time equivalent undergraduate student of institutions 

that offer similar instruction, except that the Secretary may apply the waiver 

requirements described in section 392(b) to this subparagraph in the same manner 

as the Secretary applies the waiver requirements to section 312(b)(1)(B);

 (C) has an enrollment of undergraduate students that is not less than 40 percent 

Black American students;

 (D) is legally authorized to provide, and provides, within the State an educational 

program for which the institution of higher education awards a baccalaureate 

degree or, in the case of a junior or community college, an associate's degree;

 (E) is accredited by a nationally recognized accrediting agency or association 

determined by the Secretary to be a reliable authority as to the quality of training 

offered or is, according to such an agency or association, making reasonable 

progress toward accreditation; and

 (F) is not receiving assistance under part B or part A of title V.

 (2) Enrollment of needy students.--The term “enrollment of needy students” means the 

enrollment at an eligible institution with respect to which not less than 50 percent of 

the undergraduate students enrolled in an academic program leading to a degree--

 (A) in the second fiscal year preceding the fiscal year for which the determination is 

made, were Federal Pell Grant recipients for such year;

 (B) come from families that receive benefits under a means-tested Federal benefit 

program;

 (C) attended a public or nonprofit private secondary school that--

 (i) is in the school district of a local educational agency that was eligible for 

assistance under part A of title I of the Elementary and Secondary Education 

Act of 1965 for any year during which the student attended such secondary 

school; and

 (ii) for the purpose of this paragraph and for such year of attendance, was 

determined by the Secretary (pursuant to regulations and after consultation 

with the State educational agency of the State in which the school is located) 

to be a school in which the enrollment of children meeting a measure of 

poverty under section 1113(a)(5) of such Act exceeds 30 percent of the total 

enrollment of such school; or

 (D) are first-generation college students and a majority of such first-generation 

college students are low-income individuals.

 (3) First-generation college student.--The term “first-generation college student” has 

the meaning given the term in section 402A(h).*
11

 (4) Low-income individual.--The term “low-income individual” has the meaning given 

such term in section 402A(h).**

 (5) Means-tested federal benefit program.--The term `means-tested Federal benefit 

program' means a program of the Federal Government, other than a program under 

title IV, in which eligibility for the program's benefits, or the amount of such benefits, 

are determined on the basis of income or resources of the individual or family 

seeking the benefit.

 (6) Predominantly black institution.--The term “Predominantly Black Institution” means 

an institution of higher education, as defined in section 101(a)--

 (A) that is an eligible institution with not less than 1,000 undergraduate students;

 (B) at which not less than 50 percent of the undergraduate students enrolled at the 

eligible institution are low-income individuals or first-generation college students; 

and

 (C) at which not less than 50 percent of the undergraduate students are enrolled 

in an educational program leading to a bachelor's or associate's degree that the 

eligible institution is licensed to award by the State in which the eligible institution is 

located.

 (7) State.--The term “State” means each of the 50 States and the District of Columbia.

(c) Grant Authority.--

 

(1) In general.--The Secretary is authorized to award grants, from allotments under 

subsection (e), to Predominantly Black Institutions to enable the Predominantly 

Black Institutions to carry out the authorized activities described in subsection (d).

 (2) Priority.--In awarding grants under this section the Secretary shall give priority to 

Predominantly Black Institutions with large numbers or percentages of students 

described in subsections (b)(1)(A) or (b)(1)(C). The level of priority given to 

Predominantly Black Institutions with large numbers or percentages of students 

described in subsection (b)(1)(A) shall be twice the level of priority given to 

Predominantly Black Institutions with large numbers or percentages of students 

described in subsection (b)(1)(C).

(d) Authorized Activities.—

 (1) Required activities.--Grant funds provided under this section shall be used--

 (A) to assist the Predominantly Black Institution to plan, develop, undertake, and 

implement programs to enhance the institution's capacity to serve more low-and 

middle-income Black American students;

 (B) to expand higher education opportunities for students eligible to participate in 

programs under title IV by encouraging college preparation and student persistence 

in secondary school and postsecondary education; and

 (C) to strengthen the financial ability of the Predominantly Black Institution to 

serve the academic needs of the students described in subparagraphs (A) and (B).

 (2) Additional activities.--Grant funds provided under this section shall be used for one 

or more of the following activities:

 (A) The activities described in paragraphs (1) through (12) of section 311(c).***

 (B) Academic instruction in disciplines in which Black Americans are 

underrepresented.

 (C) Establishing or enhancing a program of teacher education designed to qualify 

students to teach in a public elementary school or secondary school in the State 

that shall include, as part of such program, preparation for teacher certification or 

licensure.
12

 (D) Establishing community outreach programs that will encourage elementary 

school and secondary school students to develop the academic skills and the 

interest to pursue postsecondary education.

 (E) Other activities proposed in the application submitted pursuant to subsection 

(f) that--

 (i) contribute to carrying out the purpose of this section; and

 (ii) are approved by the Secretary as part of the review and approval of an 

application submitted under subsection (f).

(3) Endowment fund.--

 (A) In general.--A Predominantly Black Institution may use not more than 20 

percent of the grant funds provided under this section to establish or increase an 

endowment fund at the institution.

 (B) Matching requirement.--In order to be eligible to use grant funds in accordance 

with subparagraph (A), a Predominantly Black Institution shall provide matching 

funds from non-Federal sources, in an amount equal to or greater than the Federal 

funds used in accordance with subparagraph (A), for the establishment or increase 

of the endowment fund.

 (C) Comparability.--The (NOTE: Applicability) provisions of part C, regarding the 

establishment or increase of an endowment fund, that the Secretary determines are 

not inconsistent with this subsection, shall apply to funds used under subparagraph 

(A).

(4) Limitation.--Not more than 50 percent of the grant funds provided to a 

Predominantly Black Institution under this section may be available for the purpose 

of constructing or maintaining a classroom, library, laboratory, or other instructional 

facility.

(e) Allotments to Predominantly Black Institutions.—

(1) Federal Pell grant basis.--From the amounts appropriated to carry out this section 

for any fiscal year, the Secretary shall allot to each Predominantly Black Institution 

having an application approved under subsection (f) a sum that bears the same 

ratio to one-half of that amount as the number of Federal Pell Grant recipients in 

attendance at such institution at the end of the academic year preceding the 

beginning of that fiscal year, bears to the total number of Federal Pell Grant 

recipients at all such institutions at the end of such academic year.

(2) Graduates basis.--From the amounts appropriated to carry out this section for any 

fiscal year, the Secretary shall allot to each Predominantly Black Institution having 

an application approved under subsection (f) a sum that bears the same ratio to 

one-fourth of that amount as the number of graduates for such academic year at

such institution, bears to the total number of graduates for such academic year at 

all such institutions.

 (3) Graduates seeking a higher degree basis.--From the amounts appropriated to 

carry out this section for any fiscal year, the Secretary shall allot to each 

Predominantly Black Institution having an application approved under subsection 

(f) a sum that bears the same ratio to one-fourth of that amount as the percentage 

of graduates from such institution who are admitted to and in attendance at, not 

later than two years after graduation with an associate's degree or a baccalaureate 

degree, a baccalaureate degree-granting institution or a graduate or professional 

school in a degree program in disciplines in which Black American students are 

underrepresented, bears to the percentage of such graduates for all such 

institutions.

 (4) Minimum allotment.--
13

(A) In general.--Notwithstanding paragraphs (1), (2), and (3), the amount allotted to 

each Predominantly Black Institution under this section may not be less than 

$250,000.

(B) Insufficient amount.--If the amounts appropriated to carry out this section for a 

fiscal year are not sufficient to pay the minimum allotment provided under 

subparagraph (A) for the fiscal year, then the amount of such minimum allotment 

shall be ratably reduced. If additional sums become available for such fiscal year, 

such reduced allotment shall be increased on the same basis as the allotment was 

reduced until the amount allotted equals the minimum allotment required under 

subparagraph (A).

 (5) Reallotment.--The amount of a Predominantly Black Institution's allotment under 

paragraph (1), (2), (3), or (4) for any fiscal year that the Secretary determines will 

not be needed for such institution for the period for which such allotment is 

available, shall be available for reallotment to other Predominantly Black Institutions 

in proportion to the original allotments to such other institutions under this section 

for such fiscal year. The Secretary shall reallot such amounts from time to time, on 

such date and during such period as the Secretary determines appropriate.

(f) Applications.--Each Predominantly Black Institution desiring a grant under this section 

shall submit an application to the Secretary at such time, in such manner, and containing 

or accompanied by such information as the Secretary may reasonably require.

(g) Application Review Process.--Section 393 shall not apply to applications under this 

section.

(h) Duration and Carryover.--Any grant funds paid to a Predominantly Black Institution 

under this section that are not expended or used for the purposes for which the funds 

were paid within ten years following the date on which the grant was awarded, shall be 

repaid to the Treasury.

(i) Special Rule on Eligibility.--No Predominantly Black Institution that receives funds 

under this section shall concurrently receive funds under any other provision of this part, 

part B, or part A of title V.

*First Generation College Student – For the purposes of this part, the term “first 

generation college student” means -

(A) an individual both of whose parents did not complete a baccalaureate degree; 

or

(B) in the case of any individual who regularly resided with and received support 

from one parent, an individual whose only such parent did not complete a 

baccalaureate degree.

**Low-Income Individual -For the purpose of this part, the term “low-income individual” 

means an individual from a family whose taxable income for the preceding year did not 

exceed 150 percent of an amount equal to the poverty level determined by using criteria 

of poverty established by the Bureau of the Census.

*** PART A STRENGTHENING INSTITUTIONS

(c) AUTHORIZED ACTIVITIES.--Grants awarded under this section shall be used for 1 

or more of the following activities:

(1) Purchase, rental, or lease of scientific or laboratory equipment for educational 

purposes, including instructional and research purposes.
14

(2) Construction, maintenance, renovation, and improvement in classrooms, libraries, 

laboratories, and other instructional facilities, including the integration of computer 

technology into institutional facilities to create smart buildings.

(3) Support of faculty exchanges, faculty development, and faculty fellowships to assist 

in attaining advanced degrees in the field of instruction of the faculty.

(4) Development and improvement of academic programs 

(5) Purchase of library books, periodicals, and other educational materials, including 

telecommunications program material.

(6) Tutoring, counseling, and student service programs designed to improve academic 

success, including innovative, customized, instruction courses designed to help 

retain students and move the students rapidly into core courses and through 

program completion, which may include remedial education and English language 

instruction

(7) Education or counseling services designed to improve the financial literacy and 

economic literacy of students or the students' families.

(8) Funds management, administrative management, and acquisition of equipment for 

use in strengthening funds management.

(9) Joint use of facilities, such as laboratories and libraries.

(10) Establishing or improving a development office to strengthen or improve 

contributions from alumni and the private sector.

(11) Establishing or improving an endowment fund.

(12) Creating or improving facilities for Internet or other distance learning technologies, 

including purchase or rental of telecommunications technology equipment or 

services.

(13) Other activities proposed in the application submitted pursuant to subsection (b) 

and section 391 that-

(A) contribute to carrying out the purposes of the program assisted under this part; 

and

(B) are approved by the Secretary as part of the review and acceptance of such 

application.
15

4000-01-U

DEPARTMENT OF EDUCATION

Applications for New Awards; Predominantly Black 

Institutions Formula Grant Program

AGENCY: Office of Postsecondary Education, Department of 

Education.

ACTION: Notice.

Overview Information:

Predominantly Black Institutions (PBI) Formula Grant 

Program

Notice inviting applications for new awards for fiscal year 

(FY) 2016.

Catalog of Federal Domestic Assistance (CFDA) Number:

84.031P.

Dates:

Applications Available: February 1, 2016

Deadline for Transmittal of Phase I of Applications: 

March 2, 2016

Deadline for Transmittal of Phase II of Applications: 

April 1, 2016

Full Text of Announcement

I. Funding Opportunity Description

Purpose of Program: The Predominantly Black Institutions 

(PBI) Formula Grant Program provides grants to eligible 
16

institutions to plan, develop, undertake, and implement 

programs that enhance their capacity to serve more low- and 

middle-income Black American students; to expand higher 

education opportunities for eligible students by 

encouraging college preparation and student persistence in 

secondary school and postsecondary education; and to 

strengthen the financial ability of the institutions to 

serve the academic needs of these students.

Program Authority: Title III, part A, section 318 of the

Higher Education Act of 1965, as amended (HEA) (20 U.S.C. 

1059e).

Applicable Regulations: (a) The Education Department 

General Administrative Regulations (EDGAR) in 34 CFR parts 

75, 77, 82, 84, 86, 97, 98, and 99. (b) The OMB 

Guidelines to Agencies on Governmentwide Debarment and

Suspension (Nonprocurement) in 2 CFR part 180, as adopted 

and amended as regulations of the Department in 2 CFR part 

3485. (c) The Uniform Administrative Requirements, Cost 

Principles, and Audit Requirements for Federal Awards in 2 

CFR part 200, as adopted and amended as regulations of the 

Department in 2 CFR part 3474.

II. Award Information

Type of Award: Formula grant.

Estimated Available Funds: $9,942,000.
17

Estimated Average Size of Awards: Grants awarded under the 

PBI Formula Grant Program are allotted to eligible 

institutions based on the formula included in section 

318(e) of the HEA (20 U.S.C. 1059e(e)), with no grantee 

allotted less than $250,000.

If the amount appropriated for this program for a 

fiscal year is not sufficient to pay the minimum allotment 

to eligible institutions, then the amount of the minimum 

allotment must be ratably reduced, in accordance with 

section 318(e) of the HEA (20 U.S.C. 1059e(e)(4)).

Funding Formula:

Grant amounts to PBIs are awarded according to the 

following formula:

(1) Federal Pell Grant basis--From the amount 

appropriated for this program for any fiscal year, the 

Secretary allots to each PBI with an approved application a 

sum that bears the same ratio to one-half of that amount as 

the number of Federal Pell Grant recipients in attendance 

at such institution at the end of the academic year 

preceding the beginning of that fiscal year, bears to the 

total number of Federal Pell Grant recipients at all such 

institutions at the end of such academic year.

(2) Graduates basis--From the amount appropriated for 

this program for any fiscal year, the Secretary allots to 

each PBI with an approved application a sum that bears the 
18

same ratio to one-fourth of that amount as the number of 

graduates for such academic year at such institution, bears 

to the total number of graduates for such academic year at 

all such institutions.

(3) Graduates seeking a higher degree basis--From the 

amount appropriated for this program for any fiscal year, 

the Secretary allots to each PBI with an approved 

application a sum that bears the same ratio to one-fourth 

of that amount as the percentage of graduates from such 

institution who are admitted to and in attendance at, not 

later than two years after graduation with an associate's 

degree or a baccalaureate degree, a baccalaureate degreegranting institution or a graduate or professional school 

in a degree program in disciplines in which Black American 

students are underrepresented, bears to the percentage of 

such graduates for all such institutions.

Estimated Number of Awards: All applicant institutions 

that meet the eligibility requirements will receive a 

portion of the total appropriations for the PBI Formula 

Grant Program.

Note: The Department is not bound by any estimates in this 

notice.

Project Period: 60 months.

III. Eligibility Information

1. Eligible Applicants: An applicant must--
19

(a) Have an enrollment of needy undergraduate 

students as defined in section 318(b)(2) of the HEA (20 

U.S.C. 1059e(b)(2));

(b) Have an average educational and general 

expenditure that is low, per full-time equivalent 

undergraduate student, in comparison with the average 

educational and general expenditure per full-time 

equivalent undergraduate student of institutions that offer 

similar instruction, except that the Secretary may apply 

the waiver requirements described in section 392(b) of the 

HEA (20 U.S.C. 1068a(b)) to this subparagraph in the same 

manner as the Secretary applies the waiver requirements to 

section 312(b)(1)(B) of the HEA (20 U.S.C. 1058(b)(1)(B));

(c) Have an enrollment of undergraduate students that 

is not less than 40 percent Black American students 

(section 318(b)(1)(C) of the HEA; 20 U.S.C. 1059e 

(b)(1)(C));

(d) Be legally authorized to provide, and provide, 

within the State, an educational program for which the 

institution of higher education awards a baccalaureate 

degree or, in the case of a junior or community college, an 

associate's degree (section 318(b)(1)(D) of the HEA; 20 

U.S.C. 1059e(b)(1)(D));

(e) Be accredited by a nationally recognized 

accrediting agency or association determined by the 
20

Secretary to be a reliable authority as to the quality of 

training offered or is, according to such an agency or 

association, making reasonable progress toward 

accreditation (section 318(b)(1)(E) of the HEA (20 U.S.C. 

1059e(b)(1)(E))); and

(f) Not be receiving funds under any other provision 

of part A or part B of title III of the HEA or part A of 

title V of the HEA (sections 318(b)(1)(F) and 318(i) of the 

HEA; 20 U.S.C. 1059e(b)(1)(F) and 1059e(i)).

To be eligible for a grant under the PBI Formula Grant 

Program, an applicant must also meet the definition of a 

Predominantly Black Institution in section 318(b)(6) of the 

HEA (20 U.S.C. 1059e(b)(6)). The term Predominantly Black 

Institution means an institution of higher education, as 

defined in section 101(a) of the HEA (20 U.S.C. 1001(a))--

(i) That is an eligible institution with not less 

than 1,000 undergraduate students;

(ii) At which not less than 50 percent of the 

undergraduate students enrolled at the eligible institution 

are low-income individuals or first-generation college 

students; and

(iii) At which not less than 50 percent of the 

undergraduate students are enrolled in an educational 

program leading to a bachelor's or associate's degree that 

the eligible institution is licensed to award by the State 
21

(defined as each of the 50 States and the District of 

Columbia) in which the eligible institution is located.

Note: The notice announcing the FY 2016 process for 

designation of eligible institutions, and inviting 

applications for waiver of eligibility requirements, was 

published in the Federal Register on November 19, 2015 (80 

FR 72422). Only institutions that the Department 

determines are eligible, or are granted a waiver, may apply 

for a grant under this program.

2. Cost Sharing or Matching: This program does not 

require cost sharing or matching unless the grantee uses a 

portion of its grant for establishing or improving an 

endowment fund. If a grantee uses a portion of its grant 

for endowment fund purposes, it must match those grant 

funds with non-Federal funds in an amount equal to or 

greater than the Federal funds used for the establishment 

or increase of the endowment fund (section 318(d)(3) of the 

HEA (20 U.S.C. 1059e(d)(3)).

IV. Application and Submission Information

1. Address to Request Application Package: 

Bernadette D. Miles, OPE, Institutional Service, U.S. 

Department of Education, 400 Maryland Avenue, SW., room 

7E311, Washington, DC 20202. Telephone: (202) 502-7616, 

or by email: bernadette.miles@ed.gov.
22

If you use a telecommunications device for the deaf 

(TDD) or a text telephone (TTY), call the Federal Relay 

Service (FRS), toll free, at 1-800-877-8339.

Individuals with disabilities can obtain a copy of the 

application package in an accessible format (e.g., braille, 

large print, audiotape, or compact disc) by contacting the 

program contact person listed in this section.

2. Content and Form of Application Submission: 

Requirements concerning the content of an application, 

together with the forms you must submit, are in the 

application package for this program. The application 

process for this program has two phases: Phase I will 

require submitting 2014–2015 data used to run the funding 

formula; Phase II will require submission of the narrative 

project plan and standard forms. The deadline dates for 

submitting Phases I and II of the application are listed in 

this notice. Other requirements concerning the content of 

an application, together with the forms you must submit, 

are in the application package for this program.

3. Submission Dates and Times:

Applications Available: February 1, 2016

Deadline for Transmittal of Phase I of Applications: 

March 2, 2016

Deadline for Transmittal of Phase II of Applications: 

April 1, 2016.
23

Applications for grants under this program must be 

submitted electronically as an email attachment to 

pbiprogram@ed.gov by 4:30:00 p.m., Washington, DC time, on 

the deadline date.

We do not consider an application that does not comply 

with the deadline requirements.

Individuals with disabilities who need an 

accommodation or auxiliary aid in connection with the 

application process should contact the person listed under 

For Further Information Contact in section VII of this 

notice. If the Department provides an accommodation or 

auxiliary aid to an individual with a disability in 

connection with the application process, the individual’s 

application remains subject to all other requirements and 

limitations in this notice.

4. Intergovernmental Review: This program is not 

subject to Executive Order 12372 and the regulations in 34 

CFR part 79.

5. Funding Restrictions: We reference regulations 

outlining funding restrictions in the Applicable 

Regulations section of this notice.

6. Data Universal Numbering System Number, Taxpayer 

Identification Number, and System for Award Management: To 

do business with the Department of Education, you must--
24

 a. Have a Data Universal Numbering System (DUNS) 

number and a Taxpayer Identification Number (TIN);

 b. Register both your DUNS number and TIN with the 

System for Award Management (SAM) (formerly the Central 

Contractor Registry), the Government’s primary registrant 

database;

 c. Provide your DUNS number and TIN on your 

application; and

 d. Maintain an active SAM registration with current 

information while your application is under review by the 

Department and, if you are awarded a grant, during the 

project period.

You can obtain a DUNS number from Dun and Bradstreet 

at the following Web site: http://fedgov.dnb.com/webform. 

A DUNS number can be created within one to two business 

days.

If you are a corporate entity, agency, institution, or 

organization, you can obtain a TIN from the Internal 

Revenue Service. If you are an individual, you can obtain 

a TIN from the Internal Revenue Service or the Social 

Security Administration. If you need a new TIN, please 

allow two to five weeks for your TIN to become active.

The SAM registration process can take approximately 

seven business days, but may take upwards of several weeks, 

depending on the completeness and accuracy of the data you 
25

enter into the SAM database. Thus, if you think you might 

want to apply for Federal financial assistance under a 

program administered by the Department, please allow 

sufficient time to obtain and register your DUNS number and 

TIN. We strongly recommend that you register early.

If you are currently registered with SAM, you may not 

need to make any changes. However, please make certain 

that the TIN associated with your DUNS number is correct. 

Also note that you will need to update your registration 

annually. This may take three or more business days.

Information about SAM is available at www.SAM.gov. To 

further assist you with obtaining and registering your DUNS 

number and TIN in SAM or updating your existing SAM 

account, we have prepared a SAM.gov Tip Sheet, which you 

can find at: 

www2.ed.gov/fund/grant/apply/sam-faqs.html.

7. Other Submission Requirements: Applications for 

grants under this program must be submitted electronically 

unless you qualify for an exception to this requirement in 

accordance with the instructions in this section.

a. Electronic Submission of Applications.

Applications for grants under the Predominantly Black 

Institutions Formula Grant Program, CFDA number 84.031P, 

must be submitted electronically via e-mail to 

pbiprogram@ed.gov.
26

We will reject your application if you submit it in 

paper format unless, as described elsewhere in this 

section, you qualify for one of the exceptions to the 

electronic submission requirement and submit, no later than 

two weeks before the application deadline date, a written 

statement to the Department that you qualify for one of 

these exceptions. Further information regarding 

calculation of the date that is two weeks before the 

application deadline date is provided later in this section 

under Exception to Electronic Submission Requirement.

You may access the electronic grant application for 

the PBI Program at www2.ed.gov/programs/pbihea/index.html.

Please note the following:

• You must complete the electronic submission of your 

grant application by 4:30:00 p.m., Washington, DC time, on 

the application deadline date. We will not accept an 

application for this program after 4:30:00 p.m., 

Washington, DC time, on the application deadline date. 

Therefore, we strongly recommend that you do not wait until 

the application deadline date to begin the application 

process.

• You will not receive additional point value because 

you submit your application in electronic format, nor will 

we penalize you if you qualify for an exception to the 

electronic submission requirement, as described elsewhere 
27

in this section, and submit your application in paper 

format.

• You must submit all documents electronically, 

including all information you typically provide on the 

following forms: the Application for Federal Assistance 

(SF 424), the Department of Education Supplemental 

Information for SF 424, Budget Information--NonConstruction Programs (ED 524), and all necessary 

assurances and certifications. 

• You must attach any narrative sections of your 

application as files in a .DOC (document), .RTF (rich 

text), or .PDF (Portable Document) format. If you upload a 

file type other than the three file types specified in this 

paragraph or submit a password protected file, we will not 

review that material.

• Your electronic application must comply with any 

page limit requirements described in this notice.

• Prior to submitting your electronic application, 

you may wish to print a copy of it for your records.

• Within three working days after submitting Phase II 

of your electronic application, fax a signed copy of the SF 

424 to the Application Control Center after following these 

steps:

(1) Print SF 424 from e-Application.
28

(2) The applicant’s Authorizing Representative must 

sign this form.

(3) Place the PR/Award number in the upper right hand 

corner of the hard-copy signature page of the SF 424.

(4) Fax the signed SF 424 to the Application Control 

Center at (202) 245-6272.

• We may request that you provide us original 

signatures on other forms at a later date.

Exception to Electronic Submission Requirement: You 

qualify for an exception to the electronic submission 

requirement, and may submit your application in paper 

format, if you are unable to submit an application via 

email because––

• You do not have access to the Internet;

and

• No later than two weeks before the application 

deadline date (14 calendar days or, if the fourteenth 

calendar day before the application deadline date falls on 

a Federal holiday, the next business day following the 

Federal holiday), you mail or fax a written statement to 

the Department, explaining that you do not have access to 

the Internet. 

If you mail your written statement to the Department, 

it must be postmarked no later than two weeks before the 

application deadline date. If you fax your written 
29

statement to the Department, we must receive the faxed 

statement no later than two weeks before the application 

deadline date.

Address and mail or fax your statement to: Bernadette 

D. Miles, OPE, Institutional Service, U.S. Department of 

Education, 400 Maryland Avenue, S.W., room 7E311, 

Washington, DC 20202. Fax: (202) 205-0063.

Your paper application must be submitted in accordance 

with the mail or hand delivery instructions described in 

this notice.

b. Submission of Paper Applications by Mail.

If you qualify for an exception to the electronic 

submission requirement, you may mail (through the U.S. 

Postal Service or a commercial carrier) your application to 

the Department. You must mail the original and two copies 

of your application, on or before the application deadline 

date, to the Department at the following address:

U.S. Department of Education

Application Control Center

Attention: (CFDA Number 84.031P)

LBJ Basement Level 1

400 Maryland Avenue, S.W.

Washington, DC 20202-4260

You must show proof of mailing consisting of one of 

the following:

(1) A legibly dated U.S. Postal Service postmark.

(2) A legible mail receipt with the date of mailing 

stamped by the U.S. Postal Service.
30

(3) A dated shipping label, invoice, or receipt from 

a commercial carrier. 

(4) Any other proof of mailing acceptable to the 

Secretary of the U.S. Department of Education.

If you mail your application through the U.S. Postal 

Service, we do not accept either of the following as proof

of mailing:

(1) A private metered postmark. 

(2) A mail receipt that is not dated by the U.S. 

Postal Service.

Note: The U.S. Postal Service does not uniformly provide a 

dated postmark. Before relying on this method, you should 

check with your local post office.

We will not consider applications postmarked after the 

application deadline date.

c. Submission of Paper Applications by Hand Delivery.

If you qualify for an exception to the electronic 

submission requirement, you (or a courier service) may 

deliver your paper application to the Department by hand. 

You must deliver the original and two copies of your 

application by hand, on or before the application deadline 

date, to the Department at the following address:

U.S. Department of Education

Application Control Center

Attention: (CFDA Number 84.031P)

550 12th Street, S.W.

Room 7039, Potomac Center Plaza

Washington, DC 20202-4260
31

The Application Control Center accepts hand deliveries 

daily between 8:00 a.m. and 4:30:00 p.m., Washington, DC 

time, except Saturdays, Sundays, and Federal holidays.

Note for Mail or Hand Delivery of Paper Applications: If 

you mail or hand deliver your application to the 

Department--

(1) You must indicate on the envelope and--if not 

provided by the Department--in Item 11 of the SF 424 the 

CFDA number, including suffix letter, if any, of the 

competition under which you are submitting your 

application; and

(2) The Application Control Center will mail to you a 

notification of receipt of your grant application. If you 

do not receive this notification within 15 business days 

from the application deadline date, you should call the 

U.S. Department of Education Application Control Center at 

(202) 245-6288.

V. Application Review Information

1. Review and Selection Process: After eligibility is 

determined, Department staff will begin a two stage process 

to--

(1) Determine grant awards based on the formula in 

section 318(e) of the HEA (20 U.S.C. 1059e(e)); and
32

(2) Ensure that all activities proposed in the 

application are allowable under section 318(d) of the HEA 

(20 U.S.C. 1059e(d)).

We remind potential applicants that in reviewing 

applications in any discretionary grant competition, the 

Secretary may consider, under 34 CFR 75.217(d)(3), the past 

performance of the applicant in carrying out a previous 

award, such as the applicant’s use of funds, achievement of 

project objectives, and compliance with grant conditions. 

The Secretary may also consider whether the applicant 

failed to submit a timely performance report or submitted a 

report of unacceptable quality.

In addition, in making a grant award, the Secretary 

requires various assurances including those applicable to 

Federal civil rights laws that prohibit discrimination in 

programs or activities receiving Federal financial 

assistance from the Department of Education (34 CFR 100.4, 

104.5, 106.4, 108.8, and 110.23).

2. Risk Assessment and Special Conditions:

Consistent with 2 CFR 200.205, before awarding grants under 

this program, the Department conducts a review of the risks 

posed by applicants. Under 2 CFR 3474.10, the Secretary 

may impose special conditions and, in appropriate 

circumstances, high-risk conditions on a grant if the 

applicant or grantee is not financially stable; has a 
33

history of unsatisfactory performance; has a financial or 

other management system that does not meet the standards in 

2 CFR part 200, subpart D; has not fulfilled the conditions 

of a prior grant; or is otherwise not responsible.

VI. Award Administration Information

1. Award Notices: If your application is successful, 

we notify your U.S. Representative and U.S. Senators and 

send you a Grant Award Notification (GAN); or we may send 

you an email containing a link to access an electronic 

version of your GAN. We may notify you informally, also.

If your application is not evaluated or not selected 

for funding, we notify you.

2. Administrative and National Policy Requirements: 

We identify administrative and national policy requirements 

in the application package and reference these and other 

requirements in the Applicable Regulations section of this 

notice.

We reference the regulations outlining the terms and 

conditions of an award in the Applicable Regulations

section of this notice and include these and other specific 

conditions in the GAN. The GAN also incorporates your 

approved application as part of your binding commitments 

under the grant.

3. Reporting: (a) If you apply for a grant under 

this competition, you must ensure that you have in place 
34

the necessary processes and systems to comply with the 

reporting requirements in 2 CFR part 170 should you receive 

funding under the competition. This does not apply if you 

have an exception under 2 CFR 170.110(b).

(b) At the end of your project period, you must 

submit a final performance report, including financial 

information, as directed by the Secretary. If you receive 

a multiyear award, you must submit an annual performance 

report that provides the most current performance and 

financial expenditure information as directed by the 

Secretary under 34 CFR 75.118. The Secretary may also 

require more frequent performance reports under 34 CFR 

75.720(c). For specific requirements on reporting, please 

go to

www.ed.gov/fund/grant/apply/appforms/appforms.html.

(C) Under 34 CFR 75.250(b), the Secretary may provide 

a grantee with additional funding for data collection 

analysis and reporting. In this case the Secretary 

establishes a data collection period.

4. Performance Measures: The Department has 

established the following Government Performance and 

Results Act of 1993 (GPRA) performance measures for the PBI 

Formula Grant Program: 

(a) Enrollment Rate: The percentage change of the 

number of full-time degree-seeking undergraduate students 
35

enrolled at PBIs. Note that this is a long-term measure, 

which will be used to periodically gauge performance.

(b) Persistence Rate--four-year institutions: The 

percentage of first-time, full-time degree-seeking 

undergraduate students at four-year PBIs who were in their 

first year of postsecondary enrollment in the previous year 

and are enrolled in the current year at the same four-year 

PBI.

(c) Persistence Rate--two-year institutions: The 

percentage of first-time, full-time degree-seeking

undergraduate students at two-year PBIs who were in their 

first year of postsecondary enrollment in the previous year 

and are enrolled in the current year at the same two-year 

PBI.

(d) Completion Rate--four-year institutions: The 

percentage of first-time, full-time degree-seeking 

undergraduate students enrolled at four-year PBIs who 

graduate within six years of enrollment.

(e) Completion Rate--two-year institutions: The 

percentage of first-time, full-time degree-seeking 

undergraduate students enrolled at two-year PBIs who 

graduate within three years of enrollment.

(f) Efficiency Measure: Cost per successful program 

outcome: Federal cost per undergraduate degree at PBIs.
36

5. Continuation Awards: In making a continuation 

award under 34 CFR 75.253, the Secretary considers, among 

other things: whether a grantee has made substantial 

progress in achieving the goals and objectives of the 

project; whether the grantee has expended funds in a manner 

that is consistent with its approved application and 

budget; and, if the Secretary has established performance 

measurement requirements, the performance targets in the 

grantee’s approved application.

In making a continuation award, the Secretary also 

considers whether the grantee is operating in compliance 

with the assurances in its approved application, including 

those applicable to Federal civil rights laws that prohibit 

discrimination in programs or activities receiving Federal 

financial assistance from the Department (34 CFR 100.4, 

104.5, 106.4, 108.8, and 110.23).

VII. Agency Contact 

For Further Information Contact: Bernadette D. Miles, OPE, 

Institutional Service, U.S. Department of Education, 400 

Maryland Avenue, S.W., room 7E311, Washington, DC 20202. 

Telephone: (202) 502-7616, or by e-mail: 

bernadette.miles@ed.gov.

If you use a TDD or a TTY, call the FRS, toll free, at 

1-800-877-8339.

Section A. VIII. Other Information
37

Accessible Format: Individuals with disabilities can 

obtain this document and a copy of the application package 

in an accessible format (e.g., braille, large print, 

audiotape, or compact disc) on request to the program 

contact person listed under For Further Information Contact

in section VII of this notice.

Electronic Access to This Document: The official version 

of this document is the document published in the Federal 

Register. Free Internet access to the official edition of 

the Federal Register and the Code of Federal Regulations is 

available via the Federal Digital System at: 

www.gpo.gov/fdsys. At this site you can view this 

document, as well as all other documents of this Department 

published in the Federal Register, in text or Adobe 

Portable Document Format (PDF). To use PDF you must have 

Adobe Acrobat Reader, which is available free at the site. 
38

You may also access documents of the Department 

published in the Federal Register by using the article 

search feature at: www.federalregister.gov. Specifically, 

through the advanced search feature at this site, you can 

limit your search to documents published by the Department.

Dated: 

/Signed/

_____________________________

Lynn B. Mahaffie,

Deputy Assistant Secretary 

for Policy, Planning, and 

Innovation Delegated the 

Duties of the Assistant 

Secretary for Postsecondary 

Education
39

INSTRUCTIONS FOR COMPLETING THE 

APPLICATION

Part I. Formula Data

Part I of the application is the submission of information required for the Department to 

determine whether or not an institution qualifies as a PBI, and to calculate how much 

funding a PBI will receive, based on the formula established in the program legislation. 

The information will be submitted on this form, pages 38-40, which the applicant will 

submit to the program office at pbiprogram@ed.gov as an email attachment by

March 2, 2016. In order to calculate how much all grantee institutions will receive, it is

essential that Part I of the application, the Formula Data, be submitted on time. No 

calculations can be made until all PBIs have submitted the required information in full. 

Once determinations have been made, institutions will be informed whether or not it 

qualifies as a PBI, and if so, the institution will also be notified of the amount it will 

receive. Applicants are strongly encouraged not to wait for this notification before 

beginning Part II of the application.

After completing and signing this form, please scan and email it (all three pages) to

pbiprogram@ed.gov. If you do not have scanning capability, you may fax the 

signed copy to: Predominantly Black Institutions Program, Fax No. (202) 502-7861. 

THIS INFORMATION MUST BE SUBMITTED BY March 2, 2016. 

Legal Name of Institution:

Address: 

City: State: Zip: 

Eligibility

The following information is required to determine whether or not your institution 

qualifies as a Predominantly Black Institution according to the program statute and is 

eligible for funding under this program.

1. What is your institution’s enrollment of needy students*? 

___________________________

2. What was your institution’s average educational and general expenditure per 

full-time equivalent undergraduate student for the 2014-2015 academic year?

_________________________________________________________

3. What was your institution’s undergraduate enrollment for the 2014-2015 

academic year? ______________

For the 2014-2015 academic year, how many students in this undergraduate 

enrollment were:

3a. Low-income individuals*? _______________
40

3b. First generation college students*? ___________

3c. Black Americans? _______________

3d. Enrolled in an educational program at your institution leading to 

a bachelor’s or associate’s degree? _________________________

4. Is your institution receiving funding from another program under Title III, 

Parts A or B; or Title V; or authorized to receive an annual appropriation 

under the Act of March 2, 1867 (14 Stat. 438; 20 U.S.C. 123)?

___________________ 

If so, which program(s)? 

______________________________________________________________

5. Is your institution currently accredited by a nationally recognized accrediting 

agency or association? 

______________________________________________

*see page 12 for definition

Funding Formula Data

The formula has three elements. Applicants must submit accurate information on all 

three elements so that the awards may be calculated correctly.

1. Federal Pell Grant Basis

From the amounts appropriated to carry out this section for any fiscal year, the 

Secretary of Education must allot to each Predominantly Black Institution having an 

application approved by the Department of Education a sum that bears the same ratio 

to one-half of that amount as the number of Federal Pell Grant recipients in 

attendance at such institution at the end of the academic year preceding the beginning 

of that fiscal year, bears to the total number of Federal Pell Grant recipients at all 

such institutions at the end of such academic year.

Please submit the number of Pell Grant recipients in attendance at your institution 

at the end of academic year (AY) 2014-2015: _______________________________

2. Graduates Basis

From the amounts appropriated to carry out this section for any fiscal year, the 

Secretary of Education must allot to each Predominantly Black Institution having an 
41

application approved by the Department of Education a sum that bears the same ratio 

to one-fourth of that amount as the number of graduates for such academic year at 

such institution, bears to the total number of graduates for such academic year at all 

such institutions.

3. Graduates Seeking a Higher Degree Basis

From the amounts appropriated to carry out this section for any fiscal year, the 

Secretary of Education must allot to each Predominantly Black Institution having an 

application approved by the Department of Education a sum that bears the same ratio 

to one-fourth of that amount as the percentage of graduates from such institution who 

are admitted to and in attendance at, not later than two years after graduation with an 

associate's degree or a baccalaureate degree, a baccalaureate degree-granting 

institution or a graduate or professional school in a degree program in disciplines in 

which Black American students are underrepresented, bears to the percentage of such 

graduates for all such institutions.

Signature

I attest to the accuracy of the data presented on this form.

Name of Institutional Representative (printed or typed):

Signature of Institutional Representative:

Date:

2014 2015 Totals (2014+2015)

Total Number of Graduates 

from Undergraduate Class: _________________ _________________ _________________

Number of Graduates of 

Your Institution Admitted 

to and in Attendance at a 

Baccalaureate degreegranting institution or a 

Graduate or Professional 

School in a Degree 

Program in Disciplines in 

which Black American 

Students are 

Underrepresented: ___________________ _________________ __________________
42

Part II. Project Plan

Part II of the application is the Project Plan. The deadline for transmittal of Part II of the 

application is April 1, 2016. Part II of the application must be submitted with Part III of 

the application as an e-mail attachment to pbiprogram@ed.gov. 

A. Abstract: Applicants must provide a one-page overview of the project and 

planned activities, demonstrating how the project will enhance the institution’s 

capacity to serve more low- and middle-income Black American students.

B. Project Narrative: Applicants must provide a project narrative of no more than 

50 pages that describes how the institution will strengthen its ability to enhance 

higher education opportunities for low-income and Black American students. The 

narrative should address the following key topics:

1. Need for the Project: Please give a comprehensive analysis of your 

institution’s strengths and weaknesses, and describe how specific weaknesses 

in services, infrastructure, or opportunities will be addressed by the proposed 

project. Please describe how the proposed project directly relates to the 

purpose of the PBI program, and will improve the institution’s capacity to 

serve its target student populations.

2. Project Design: Please describe the goals and objectives of the proposed 

project, the activities that will address these goals and objectives, and an 

implementation plan for each activity. Please describe how the activities will 

result in clearly defined and measurable project outcomes. Where applicable, 

please include an explanation of how each activity in the proposed project 

reflects up-to-date knowledge from research and effective practice.

3. Project Services: Please describe how the services provided by the 

proposed project are appropriate to the needs of the intended recipients, the 

likely impact of the project services on the intended recipients, and how the 

services are of sufficient quality, intensity and duration to lead to 

improvements in practice of the recipients.

4. Project Personnel: Please describe the qualifications, including relevant 

training and experience, of the project director and other key personnel.

5. Resources: Please describe the level of commitment by the institution’s 

management and key stakeholders to supporting the activities of the proposed 

project and achieving the goals and objectives of the project and the program.

6. Management Plan: Please describe the management plan for the proposed 

project, and how it will ensure that the goals and objectives are achieved on 

time and within the budget, including clearly defined responsibilities, 

timelines and milestones for accomplishing project tasks. Please also 

describe the procedures for ensuring feedback and continuous improvement 

in the operation of the proposed project, and the mechanisms for ensuring 

high-quality products and services.

7. Evaluation Plan: Please describe the ways in which the methods of 

evaluation: are thorough, feasible and appropriate to the goals, objectives and 

outcomes of the proposed project; include the use of objective performance

measures that are clearly related to the intended outcomes and will produce 
43

quantitative and qualitative data; provide for examining the effectiveness of 

project implementation strategies; and will provide feedback and permit 

periodic assessment of progress toward achieving intended outcomes.

NOTE: The 50-page limit applies to the Project Narrative only. It does not 

apply to the Goals and Objectives Form or the Budget Summary or 

Narrative forms.

C. Goals and Objectives Form: For purposes of project evaluation, please 

complete the Goals and Objectives Form on page 44. Identify all of the allowable 

activities listed in the statute and on page 8 of this booklet for which the 

institution will use grant funds, the goals or objectives to be addressed by each 

activity, related baseline data, and a measurable outcome, including quantitative 

target data, developed to evaluate success. Use the example provided on the form 

for guidance.

 Allowable Activities – these are on page 8 of this application, as well as 

in the program legislation, Title III, Part A, Sec. 318(d). 

 Goals and Objectives – institutional goals and objectives to be achieved 

using PBI funding should correspond to an allowable activity. If there is 

more than one objective for a given activity, enter only one project 

objective per row and please number the goals and objectives within each 

activity. Example: the first project goal or objective associated with an 

allowable activity should be numbered “1,” the second should be 

numbered “2,” etc.

 Performance Indicators/Measures Addressed - For each project 

objective, enter each associated performance measure. These might be 

program performance measures, as listed on page 44 or they may be 

institutional or project-specific performance indicators developed by the 

institution. If there are multiple performance measures associated with a 

project objective, enter only one performance measure per row and please 

label each measure using a numerical and an alpha indicator. Example: 

the first performance measure associated with project objective “1” should 

be labeled “1 a.,” the second performance measure for project objective 

“1” should be labeled “1.b.,” etc.

 Baseline Data - Provide the baseline data for each performance measure. 

If baseline data is not available for a performance measure, please use an 

estimate. 

 Proposed Outcomes/Target Data - Provide the target data that the 

institution has established for meeting each performance measure. Every

applicant is expected to set targets for each budget period of the grant.* 

Note: If the collection of quantitative data is not appropriate for a 

particular performance measure, please provide any relevant qualitative 

data for the performance measure. If necessary, attach a narrative page to 

the form.

 Budget Period - For each objective, please provide the budget period in 

which this objective will be accomplished. If the objective will be 

achieved over more than one budget period, please indicate this.
44

*If necessary, ED may approve revised target data for a performance measure at a 

future date. 

D. Budget Form and Narrative: Please complete Budget Form 524 and the 

accompanying Budget Narrative (see pages 58 –59) in Part III of the application. 

Please address all budget periods within the project period. Please include in the 

Budget Narrative all activities for which you are requesting funding, placing them 

in the appropriate Budget Categories, and provide a detailed breakdown of the 

costs associated with each activity. 
45

Goals and Objectives Form

Please provide a detailed description of the activities to be supported using program funding: please reference the allowable activity as stated in the program 

legislation, measurable goals and objectives within the scope of these activities; associated performance indicators/measures; baseline data; proposed outcomes, 

including quantitative target data, to be used to evaluate the success of the funded activities; and the budget period(s) in which the objectives will be achieved. 

Please make sure that the information on this form reflects the goals, activities and outcomes described in your Project Narrative, especially your Evaluation Plan.

Allowable Activities Goals and Objectives

Performance 

Indicators/Measures 

Addressed Baseline Data

Proposed 

Outcomes/Target Data

Budget

Period*

Example: #3 Purchase of library 

books, periodicals, technical and 

other scientific journals, 

microfilm, microfiche, and other 

educational materials, including 

telecommunications and program 

materials.

1. Increase and expand the 

university library's collection of 

books and periodicals related to 

economics. N/A

University library currently 

maintains an economics 

collection of 150 books and 

two periodicals.

Increase university library 

economics collection to 350 

books and 5 periodicals. 3

2. Etc. 2.a.

2.b.

* Budget Periods:

1 = Academic Year 2016-2017; 2 = Academic Year 2017-2018; 3 = Academic Year 2018-2019; 4 = Academic Year 2020-2021; 5 = Academic Year 2021-2022
46

Part III. Standard Forms, Certifications and Surveys

Part III of the application, which includes the standard forms, certifications

and surveys, must be submitted with Phase II of the application, the Project 

Plan, by April 1, 2016. Part III of the application must be submitted as an 

e-mail attachment to pbiprogram@ed.gov. The signed copies of the 

standard forms may be scanned and submitted via e-mail, or faxed to: 

Predominantly Black Institutions Program, fax number (202) 502-7861.
47

OMB Number: 4040-0004

Expiration Date: 8/31/2016

Application for Federal Assistance SF-424 

*1. Type of Submission:

 Preapplication

 Application

 Changed/Corrected Application

*2. Type of Application:

 New

 Continuation

 Revision 

* If Revision, select appropriate letter(s):

 

*Other (Specify):

* 3. Date Received: 4. Applicant Identifier:

5a. Federal Entity Identifier: *5b. Federal Award Identifier:

State Use Only:

6. Date Received by State: 7. State Application Identifier: 

8. APPLICANT INFORMATION: 

*a. Legal Name: 

*b. Employer/Taxpayer Identification Number (EIN/TIN): *c. Organizational DUNS:

d. Address:

*Street 1:

 Street 2:

*City:

 County/Parish:

*State:

 Province:

*Country:

*Zip / Postal Code:

e. Organizational Unit:

Department Name: Division Name:

f. Name and contact information of person to be contacted on matters involving this application:

Prefix: *First Name: 

Middle Name:

*Last Name:

Suffix:

Title:

Organizational Affiliation:

*Telephone Number: Fax Number: 

Completed by Grants.gov upon submission
48

*Email: 

Application for Federal Assistance SF-424 

9. Type of Applicant 1: Select Applicant Type:

 

Type of Applicant 2: Select Applicant Type:

 

Type of Applicant 3: Select Applicant Type:

 

*Other (Specify)

*10 Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

*12 Funding Opportunity Number:

*Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

*15. Descriptive Title of Applicant’s Project:

Attach supporting documents as specified in agency instructions.
49

Application for Federal Assistance SF-424

16. Congressional Districts Of:

*a. Applicant: *b. Program/Project: 

Attach an additional list of Program/Project Congressional Districts if needed. 

17. Proposed Project:

*a. Start Date: *b. End Date: 

18. Estimated Funding ($):

*a. Federal

*b. Applicant

*c. State

*d. Local

*e. Other

*f. Program Income

*g. TOTAL

*19. Is Application Subject to Review By State Under Executive Order 12372 Process?

 a. This application was made available to the State under the Executive Order 12372 Process for review on 

 b. Program is subject to E.O. 12372 but has not been selected by the State for review.

 c. Program is not covered by E.O. 12372.

*20. Is the Applicant Delinquent On Any Federal Debt? (If “Yes,” provide explanation in attachment.)

 Yes No

If “Yes”, provide explanation and attach.

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the 

statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** 

and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent 

statements or claims may subject me to criminal, civil, or administrative penalties. (U. S. Code, Title 218, Section 1001)

 ** I AGREE

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or 

agency specific instructions.

Authorized Representative:

Prefix: *First Name: 

Middle Name:

*Last Name:

Suffix:

*Title: 

*Telephone Number: Fax Number: 

* Email: 

*Signature of Authorized Representative: *Date Signed: Completed by Grants.gov upon submission Completed by Grants.gov upon submission
50

INSTRUCTIONS FOR THE SF-424

This is a standard form required for use as a cover sheet for submission of pre-applications and applications and related information 

under discretionary programs. Some of the items are required and some are optional at the discretion of the applicant or the federal 

agency (agency). Required fields on the form are identified with an asterisk (*) and are also specified as “Required” in the instructions 

below. In addition to these instructions, applicants must consult agency instructions to determine other specific requirements.

Item Entry: Item: Entry:

1. Type of Submission: (Required) Select one type of 

submission in accordance with agency instructions.

• Pre-application

• Application

• Changed/Corrected Application – Check if this 

submission is to change or correct a previously submitted 

application. Unless requested by the agency, applicants 

may not use this form to submit changes after the closing 

date.

10. Name Of Federal Agency: (Required) Enter the name of the 

federal agency from which assistance is being requested 

with this application.

11. Catalog Of Federal Domestic Assistance Number/Title:

Enter the Catalog of Federal Domestic Assistance number 

and title of the program under which assistance is 

requested, as found in the program announcement, if 

applicable.

2. Type of Application: (Required) Select one type of 

application in accordance with agency instructions.

• New – An application that is being submitted to an 

agency for the first time.

• Continuation - An extension for an additional 

funding/budget period for a project with a projected 

completion date. This can include renewals.

• Revision - Any change in the federal government’s 

financial obligation or contingent liability from an existing 

obligation. If a revision, enter the appropriate letter(s). 

More than one may be selected. If "Other" is selected, 

please specify in text box provided.

A. Increase Award D. Decrease Duration

B. Decrease Award E. Other (specify)

C. Increase Duration

12. Funding Opportunity Number/Title: (Required) Enter the 

Funding Opportunity Number (FON) and title of the 

opportunity under which assistance is requested, as found 

in the program announcement. 

13. Competition Identification Number/Title: Enter the 

competition identification number and title of the 

competition under which assistance is requested, if 

applicable.

14. Areas Affected By Project: This data element is intended for 

use only by programs for which the area(s) affected are 

likely to be different than the place(s) of performance 

reported on the SF-424 Project/Performance Site 

Location(s) Form. Add attachment to enter additional 

areas, if needed.

3. Date Received: Leave this field blank. This date will be 

assigned by the Federal agency.

15. Descriptive Title of Applicant’s Project: (Required) Enter a 

brief descriptive title of the project. If appropriate, attach a 

map showing project location (e.g., construction or real 

property projects). For pre-applications, attach a summary 

description of the project. 

4. Applicant Identifier: Enter the entity identifier assigned 

buy the Federal agency, if any, or the applicant’s control 

number if applicable.

5a. Federal Entity Identifier: Enter the number assigned to 

your organization by the federal agency, if any.

16. Congressional Districts Of: 16a. (Required) Enter the 

applicant’s congressional district. 16b. Enter all district(s) 

affected by the program or project. Enter in the format: 2 

characters state abbreviation – 3 characters district 

number, e.g., CA-005 for California 5th district, CA-012 for 

California 12 district, NC-103 for North Carolina’s 103 

district. If all congressional districts in a state are affected, 

enter “all” for the district number, e.g., MD-all for all 

congressional districts in Maryland. If nationwide, i.e. all 

districts within all states are affected, enter US-all. If the 

program/project is outside the US, enter 00-000. This 

optional data element is intended for use only by programs 

for which the area(s) affected are likely to be different than 

place(s) of performance reported on the SF-424 

Project/Performance Site Location(s) Form. Attach an 

additional list of program/project congressional districts, if 

needed.

5b. Federal Award Identifier: For new applications, enter NA. 

For a continuation or revision to an existing award, enter 

the previously assigned federal award identifier number. If 

a changed/corrected application, enter the federal 

identifier in accordance with agency instructions.

6. Date Received by State: Leave this field blank. This date 

will be assigned by the state, if applicable. 

7. State Application Identifier: Leave this field blank. This 

identifier will be assigned by the state, if applicable.

8. Applicant Information: Enter the following in accordance 

with agency instructions: 

a. Legal Name: (Required) Enter the legal name of 

applicant that will undertake the assistance activity. This 

is the organization that has registered with the Central 

Contractor Registry (CCR). Information on registering with 

CCR may be obtained by visiting www.Grants.gov. 

17. Proposed Project Start and End Dates: (Required) Enter the 

proposed start date and end date of the project.
51

b. Employer/Taxpayer Number (EIN/TIN): (Required) 

Enter the employer or taxpayer identification number (EIN 

or TIN) as assigned by the Internal Revenue Service. If 

your organization is not in the US, enter 44-4444444.

18. Estimated Funding: (Required) Enter the amount 

requested, or to be contributed during the first 

funding/budget period by each contributor. Value of in-kind 

contributions should be included on appropriate lines, as 

applicable. If the action will result in a dollar change to an 

existing award, indicate only the amount of the change. For 

decreases, enclose the amounts in parentheses.

c. Organizational DUNS: (Required) Enter the 

organization’s DUNS or DUNS+4 number received from 

Dun and Bradstreet. Information on obtaining a DUNS 

number may be obtained by visiting www.Grants.gov. 

19. Is Application Subject to Review by State Under Executive 

Order 12372 Process? (Required) Applicants should contact 

the State Single Point of Contact (SPOC) for Federal 

Executive Order 12372 to determine whether the 

application is subject to the State intergovernmental review 

process. Select the appropriate box. If “a.” is selected, 

enter the date the application was submitted to the State. 

d. Address: Enter address: Street 1 (Required); city 

(Required); County/Parish, State (Required if country is 

US), Province, Country (Required), 9-digit zip/postal code 

(Required if country US). 

20. Is the Applicant Delinquent on any Federal Debt?

(Required) Select the appropriate box. This question 

applies to the applicant organization, not the person who 

signs as the authorized representative. Categories of 

federal debt include; but, may not be limited to: delinquent 

audit disallowances, loans and taxes. If yes, include an 

explanation in an attachment. 

e. Organizational Unit: Enter the name of the primary 

organizational unit, department or division that will 

undertake the assistance activity. 

21. Authorized Representative: To be signed and dated by the 

authorized representative of the applicant organization. 

Enter the first and last name (Required); prefix, middle 

name, suffix. Enter title, telephone number, email 

(Required); and fax number. A copy of the governing 

body’s authorization for you to sign this application as the 

official representative must be on file in the applicant’s 

office. (Certain federal agencies may require that this 

authorization be submitted as part of the application.)

f. Name and contact information of person to be contacted 

on matters involving this application: Enter the first and last 

name (Required); prefix, middle name, suffix, title. Enter 

organizational affiliation if affiliated with an organization 

other than that in 7.a. Telephone number and email 

(Required); fax number. 

9. Type of Applicant: (Required) Select up to three applicant 

type(s) in accordance with agency instructions. 

A. State Government

B. County Government

C. City or Township 

Government

D. Special District 

Government

E. Regional 

Organization

F. U.S. Territory or 

Possession

G. Independent School 

District

H. Public/State 

Controlled Institution 

of Higher Education

I. Indian/Native 

American Tribal 

Government 

(Federally 

Recognized)

J. Indian/Native 

American Tribal 

Government (Other 

than Federally 

Recognized)

K. Indian/Native 

American Tribally 

Designated 

Organization

L. Public/Indian 

Housing Authority

M. Nonprofit

N. Private Institution of 

Higher Education

O. Individual

P. For-Profit 

Organization (Other 

than Small 

Business)

Q. Small Business

R. Hispanic-serving 

Institution

S. Historically Black 

Colleges and 

Universities 

(HBCUs)

T. Tribally Controlled 

Colleges and 

Universities 

(TCCUs)

U. Alaska Native and 

Native Hawaiian 

Serving Institutions

V. Non-US Entity

W. Other (specify)

[U.S Department of Education note: As of spring, 2010, the FON discussed in Block 12 of the instructions can be found via the 

following URL: http://www.grants.gov/applicants/find_grant_opportunities.jsp.]
52

SUPPLEMENTAL INFORMATION

REQUIRED FOR

DEPARTMENT OF EDUCATION

1. Project Director:

Prefix: *First Name: Middle Name: *Last Name: Suffix:

Address:

* Street1:

Street2:

* City:

County:

* State * Zip Code: * Country:

* Phone Number (give area code) Fax Number (give area code)

E-mail Address:

2. Applicant Experience:

 Novice Applicant Yes No Not applicable to this program

3. Human Subjects Research:

 Are any research activities involving human subjects planned at any time during the

 proposed project Period?

Yes No

 Are ALL the research activities proposed designated to be exempt from the regulations?

Yes Provide Exemption(s) #:

No Provide Assurance #, if available:

Please attach an explanation Narrative:

OMB Control No. 1894-0007

Expiration Date: 08/31/2017

Add Attachment Delete Attachment View Attachment
53

INSTRUCTIONS FOR

DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424

1. Project Director. Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on matters 

involving this application.

2. Novice Applicant. Check “Yes” or “No” only if assistance is being requested under a program that gives special consideration to 

novice applicants. Otherwise, leave blank.

Check “Yes” if you meet the requirements for novice applicants specified in the regulations in 34 CFR 75.225 and included on the 

attached page entitled “Definitions for Department of Education Supplemental Information for SF 424.” By checking “Yes” the 

applicant certifies that it meets these novice applicant requirements. Check “No” if you do not meet the requirements for novice 

applicants.

3. Human Subjects Research. (See I. A. “Definitions” in attached page entitled “Definitions for Department of Education 

Supplemental Information For SF 424.”)

If Not Human Subjects Research. Check “No” if research activities involving human subjects are not planned at any time during the 

proposed project period. The remaining parts of Item 3 are then not applicable.

If Human Subjects Research. Check “Yes” if research activities involving human subjects are planned at any time during the 

proposed project period, either at the applicant organization or at any other performance site or collaborating institution. Check “Yes” 

even if the research is exempt from the regulations for the protection of human subjects. (See I. B. “Exemptions” in attached page 

entitled “Definitions for Department of Education Supplemental Information For SF 424.”) 

3a. If Human Subjects Research is Exempt from the Human Subjects Regulations. Check “Yes” if all the research activities 

proposed are designated to be exempt from the regulations. Insert the exemption number(s) corresponding to one or more of the six 

exemption categories listed in I. B. “Exemptions.” In addition, follow the instructions in II. A. “Exempt Research Narrative” in the 

attached page entitled “Definitions for Department of Education Supplemental Information For SF 424.” 

3a. If Human Subjects Research is Not Exempt from Human Subjects Regulations. Check “No” if some or all of the planned 

research activities are covered (not exempt). In addition, follow the instructions in II. B. “Nonexempt Research Narrative” in the page 

entitled “Definitions for Department of Education Supplemental Information For SF 424

3a. Human Subjects Assurance Number. If the applicant has an approved Federal Wide (FWA) on file with the Office for Human 

Research Protections (OHRP), U.S. Department of Health and Human Services, that covers the specific activity, insert the number in the 

space provided. If the applicant does not have an approved assurance on file with OHRP, enter “None.” In this case, the applicant, by 

signature on the SF-424, is declaring that it will comply with 34 CFR 97 and proceed to obtain the human subjects assurance upon 

request by the designated ED official. If the application is recommended/selected for funding, the designated ED official will request 

that the applicant obtain the assurance within 30 days after the specific formal request.

Note about Institutional Review Board Approval. ED does not require certification of Institutional Review Board approval with the 

application. However, if an application that involves non-exempt human subjects research is recommended/selected for funding, the 

designated ED official will request that the applicant obtain and send the certification to ED within 30 days after the formal request.

Paperwork Burden Statement. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection 

of information unless such collection displays a valid OMB control number. The valid OMB control number for this information 

collection is 1894-0007. The time required to complete this information collection is estimated to average between 15 and 45 minutes 

per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review 

the information collection. If you have any comments concerning the accuracy of the estimate(s) or suggestions for improving this form, 

please write to: U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202-4537. If you have comments or 

concerns regarding the status of your individual submission of this form write directly to: Application Control Center, U.S. Department 

of Education, Potomac Center Plaza, 550 12th Street, S.W. Room 7076, Washington, D.C. 20202-4260.
54

DEFINITIONS FOR 

DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424

(Attachment to Instructions for Supplemental Information for SF 424)

Definitions:

Novice Applicant (See 34 CFR 75.225). For discretionary 

grant programs under which the Secretary gives special 

consideration to novice applications, a novice applicant means 

any applicant for a grant from ED that—

 Has never received a grant or subgrant under the 

program from which it seeks funding;

 Has never been a member of a group application, 

submitted in accordance with 34 CFR 75.127-75.129, 

that received a grant under the program from which it 

seeks funding; and

 Has not had an active discretionary grant from the 

Federal government in the five years before the 

deadline date for applications under the program. For 

the purposes of this requirement, a grant is active 

until the end of the grant’s project or funding period, 

including any extensions of those periods that extend 

the grantee’s authority to obligate funds.

In the case of a group application submitted in accordance 

with 34 CFR 75.127-75.129, a group includes only parties that 

meet the requirements listed above.

PROTECTION OF HUMAN SUBJECTS IN 

RESEARCH

I. Definitions and Exemptions

A. Definitions.

A research activity involves human subjects if the activity is 

research, as defined in the Department’s regulations, and the 

research activity will involve use of human subjects, as 

defined in the regulations.

—Research

The ED Regulations for the Protection of Human Subjects, 

Title 34, Code of Federal Regulations, Part 97, define research 

as “a systematic investigation, including research 

development, testing and evaluation, designed to develop or 

contribute to generalizable knowledge.” If an activity follows 

a deliberate plan whose purpose is to develop or contribute to 

generalizable knowledge it is research. Activities which meet 

this definition constitute research whether or not they are 

conducted or supported under a program that is considered 

research for other purposes. For example, some 

demonstration and service programs may include research 

activities.

—Human Subject

The regulations define human subject as “a living individual 

about whom an investigator (whether professional or student) 

conducting research obtains (1) data through intervention or 

interaction with the individual, or (2) identifiable private 

information.” (1) If an activity involves obtaining information 

about a living person by manipulating that person or that 

person’s environment, as might occur when a new 

instructional technique is tested, or by communicating or 

interacting with the individual, as occurs with surveys and 

interviews, the definition of human subject is met. (2) If an 

activity involves obtaining private information about a living 

person in such a way that the information can be linked to that 

individual (the identity of the subject is or may be readily 

determined by the investigator or associated with the 

information), the definition of human subject is met. [Private 

information includes information about behavior that occurs in 

a context in which an individual can reasonably expect that no 

observation or recording is taking place, and information 

which has been provided for specific purposes by an 

individual and which the individual can reasonably expect will 

not be made public (for example, a school health record).]

B. Exemptions.

Research activities in which the only involvement of human 

subjects will be in one or more of the following six categories 

of exemptions are not covered by the regulations:

(1) Research conducted in established or commonly accepted 

educational settings, involving normal educational practices, 

such as (a) research on regular and special education 

instructional strategies, or (b) research on the effectiveness of 

or the comparison among instructional techniques, curricula, 

or classroom management methods.

(2) Research involving the use of educational tests (cognitive, 

diagnostic, aptitude, achievement), survey procedures, 

interview procedures or observation of public behavior, 

unless: (a) information obtained is recorded in such a manner 

that human subjects can be identified, directly or through 

identifiers linked to the subjects; and (b) any disclosure of the 

human subjects’ responses outside the research could 

reasonably place the subjects at risk of criminal or civil 

liability or be damaging to the subjects’ financial standing, 

employability, or reputation. If the subjects are children, 

exemption 2 applies only to research involving educational 

tests and observations of public behavior when the 

investigator(s) do not participate in the activities being 

observed. 
55

Exemption 2 does not apply if children are surveyed or 

interviewed or if the research involves observation of public 

behavior and the investigator(s) participate in the activities 

being observed. [Children are defined as persons who have 

not attained the legal age for consent to treatments or 

procedures involved in the research, under the applicable law 

or jurisdiction in which the research will be conducted.]

(3) Research involving the use of educational tests (cognitive, 

diagnostic, aptitude, achievement), survey procedures, 

interview procedures or observation of public behavior that is 

not exempt under section (2) above, if the human subjects are 

elected or appointed public officials or candidates for public 

office; or federal statute(s) require(s) without exception that 

the confidentiality of the personally identifiable information 

will be maintained throughout the research and thereafter.

(4) Research involving the collection or study of existing data, 

documents, records, pathological specimens, or diagnostic 

specimens, if these sources are publicly available or if the 

information is recorded by the investigator in a manner that 

subjects cannot be identified, directly or through identifiers 

linked to the subjects.

(5) Research and demonstration projects which are conducted 

by or subject to the approval of department or agency heads, 

and which are designed to study, evaluate, or otherwise 

examine: (a) public benefit or service programs; (b) 

procedures for obtaining benefits or services under those 

programs; (c) possible changes in or alternatives to those 

programs or procedures; or (d) possible changes in methods or 

levels of payment for benefits or services under those 

programs.

(6) Taste and food quality evaluation and consumer 

acceptance studies, (a) if wholesome foods without additives 

are consumed or (b) if a food is consumed that contains a food 

ingredient at or below the level and for a use found to be safe, 

or agricultural chemical or environmental contaminant at or 

below the level found to be safe, by the Food and Drug 

Administration or approved by the Environmental Protection 

Agency or the Food Safety and Inspection Service of the U.S. 

Department of Agriculture.

II. Instructions for Exempt and Nonexempt Human 

Subjects Research Narratives

If the applicant marked “Yes” for Item 3 of Department of 

Education Supplemental Information for SF 424, the applicant 

must provide a human subjects “exempt research” or 

“nonexempt research” narrative. Insert the narrative(s) in the 

space provided. If you have multiple projects and need to 

provide more than one narrative, be sure to label each set of 

responses as to the project they address.

A. Exempt Research Narrative.

If you marked “Yes” for item 3 a. and designated exemption 

numbers(s), provide the “exempt research” narrative. The 

narrative must contain sufficient information about the 

involvement of human subjects in the proposed research to 

allow a determination by ED that the designated exemption(s) 

are appropriate. The narrative must be succinct.

B. Nonexempt Research Narrative.

If you marked “No” for item 3 a. you must provide the 

“nonexempt research” narrative. The narrative must address 

the following seven points. Although no specific page 

limitation applies to this section of the application, be 

succinct.

(1) Human Subjects Involvement and Characteristics: 

Provide a detailed description of the proposed involvement of 

human subjects. Describe the characteristics of the subject 

population, including their anticipated number, age range, and 

health status. Identify the criteria for inclusion or exclusion of 

any subpopulation. Explain the rationale for the involvement 

of special classes of subjects, such as children, children with 

disabilities, adults with disabilities, persons with mental 

disabilities, pregnant women, prisoners, institutionalized 

individuals, or others who are likely to be vulnerable

(2) Sources of Materials: Identify the sources of research 

material obtained from individually identifiable living human 

subjects in the form of specimens, records, or data. Indicate 

whether the material or data will be obtained specifically for 

research purposes or whether use will be made of existing 

specimens, records, or data.

(3) Recruitment and Informed Consent: Describe plans for 

the recruitment of subjects and the consent procedures to be 

followed. Include the circumstances under which consent will 

be sought and obtained, who will seek it, the nature of the 

information to be provided to prospective subjects, and the 

method of documenting consent. State if the Institutional 

Review Board (IRB) has authorized a modification or waiver 

of the elements of consent or the requirement for 

documentation of consent.

(4) Potential Risks: Describe potential risks (physical, 

psychological, social, legal, or other) and assess their 

likelihood and seriousness. Where appropriate, describe 

alternative treatments and procedures that might be 

advantageous to the subjects.

(5) Protection Against Risk: Describe the procedures for 

protecting against or minimizing potential risks, including 

risks to confidentiality, and assess their likely effectiveness. 

Where appropriate, discuss provisions for ensuring necessary 

medical or professional intervention in the event of adverse 

effects to the subjects. Also, where appropriate, describe the 

provisions for monitoring the data collected to ensure the 

safety of the subjects.

(6) Importance of the Knowledge to be Gained: Discuss the 

importance of the knowledge gained or to be gained as a result 

of the proposed research. Discuss why the risks to subjects 

are reasonable in relation to the anticipated benefits to subjects 

and in relation to the importance of the knowledge that may 

reasonably be expected to result.
56

(7) Collaborating Site(s): If research involving human 

subjects will take place at collaborating site(s) or other 

performance site(s), name the sites and briefly describe their 

involvement or role in the research.

Copies of the Department of Education’s Regulations for the 

Protection of Human Subjects, 34 CFR Part 97 and other 

pertinent materials on the protection of human subjects in 

research are available from the U.S. Department of 

Education, Protection of Human Subjects Coordinator, 

Office of the Chief Financial Officer, LBJ Building, 400 

Maryland Avenue, SW, Washington, D.C. 20202-4250, 

telephone: (202) 260-3353, and on the U.S. Department of 

Education’s Protection of Human Subjects in Research Web 

Site: 

http://www.ed.gov/about/offices/list/ocfo/humansub.html

NOTE: The State Applicant Identifier on the SF 424 is for 

State Use only. Please complete it on the OMB Standard 424 

in the upper right corner of the form (if applicable).
57

U.S. DEPARTMENT OF EDUCATION

BUDGET INFORMATION

NON-CONSTRUCTION PROGRAMS 

OMB Control Number: 1894-0008

Expiration Date: 

06/30/2017 

Name of Institution/Organization Applicants requesting funding for only one year should complete the column under 

"Project Year 1." Applicants requesting funding for multi-year grants should complete all 

applicable columns. Please read all instructions before completing form.

SECTION A - BUDGET SUMMARY

I. U.S. DEPARTMENT OF EDUCATION FUNDS

Budget Categories Project Year 1

(a)

Project Year 2

(b)

Project Year 3

(c)

Project Year 4

(d)

Project Year 5

(e)

Total

(f)

1. Personnel

2. Fringe Benefits

3. Travel

4. Equipment

5. Supplies

6. Contractual

7. Construction

8. Other

9. Total Direct Costs (lines 1-8)

10. Indirect Costs*

11. Training Stipends

12. Total Costs (lines 9-11)

*Indirect Cost Information (To Be Completed by Your Business Office):

If you are requesting reimbursement for indirect costs on line 10, please answer the following questions:

(1) Do you have an Indirect Cost Rate Agreement approved by the Federal government? ____Yes ____ No 

(2) If yes, please provide the following information:

 Period Covered by the Indirect Cost Rate Agreement: From: ___/___/______ To: ___/___/______ (mm/dd/yyyy)

 Approving Federal agency: ____ ED ____ Other (please specify): __________________________ The Indirect Cost Rate is _________%

(3) For Restricted Rate Programs (check one) -- Are you using a restricted indirect cost rate that:

 ___ Is included in your approved Indirect Cost Rate Agreement? or ___ Complies with 34 CFR 76.564(c)(2)? The Restricted Indirect Cost Rate is _________%
58

ED 524

Name of Institution/Organization Applicants requesting funding for only one year should complete the column under 

"Project Year 1." Applicants requesting funding for multi-year grants should complete all 

applicable columns. Please read all instructions before completing form.

SECTION B - BUDGET SUMMARY

NON-FEDERAL FUNDS

Budget Categories

Project Year 1

(a)

Project Year 2

(b)

Project Year 3

(c)

Project Year 4

(d)

Project Year 5

(e)

Total

(f)

1. Personnel

2. Fringe Benefits

3. Travel

4. Equipment

5. Supplies

6. Contractual

7. Construction

8. Other

9. Total Direct Costs

(Lines 1-8)

10. Indirect Costs

11. Training Stipends

12. Total Costs

(Lines 9-11)

SECTION C – BUDGET NARRATIVE (see instructions)
59

General Instructions

This form is used to apply to individual U.S. Department of Education (ED) discretionary grant programs. Unless directed 

otherwise, provide the same budget information for each year of the multi-year funding request. Pay attention to applicable 

program specific instructions, if attached. You may access the Education Department General Administrative Regulations, 34 

CFR 74 – 86 and 97-99, on ED’s Web site at: http://www.ed.gov/policy/fund/reg/edgarReg/edgar.html 

You must consult with your Business Office prior to submitting this form.

Section A - Budget Summary

U.S. Department of Education Funds

All applicants must complete Section A and provide a break-down by the applicable budget categories shown in lines 1-11.

Lines 1-11, columns (a)-(e): For each project year for which funding is requested, show the total amount requested for each 

applicable budget category.

Lines 1-11, column (f): Show the multi-year total for each budget category. If funding is requested for only one project year, 

leave this column blank.

Line 12, columns (a)-(e): Show the total budget request for each project year for which funding is requested.

Line 12, column (f): Show the total amount requested for all project years. If funding is requested for only one year, leave this 

space blank.

Indirect Cost Information: If you are requesting reimbursement for indirect costs on line 10, this information is to be completed 

by your Business Office. (1): Indicate whether or not your organization has an Indirect Cost Rate Agreement that was approved 

by the Federal government. 

If you checked “no,” ED generally will authorize grantees to use a temporary rate of 10 percent of budgeted salaries and wages 

subject to the following limitations: 

(a) The grantee must submit an indirect cost proposal to its cognizant agency within 90 days after ED issues a grant 

award notification; and 

(b) If after the 90-day period, the grantee has not submitted an indirect cost proposal to its cognizant agency, the 

grantee may not charge its grant for indirect costs until it has negotiated an indirect cost rate agreement with its cognizant 

agency. 

(2): If you checked “yes” in (1), indicate in (2) the beginning and ending dates covered by the Indirect Cost Rate 

Agreement. In addition, indicate whether ED, another Federal agency (Other) or State agency issued the approved agreement. 

If you check “Other,” specify the name of the Federal or other agency that issued the approved agreement. 

(3): If you are applying for a grant under a Restricted Rate Program (34 CFR 75.563 or 76.563), indicate whether you 

are using a restricted indirect cost rate that is included on your approved Indirect Cost Rate Agreement or whether you are using 

a restricted indirect cost rate that complies with 34 CFR 76.564(c)(2). Note: State or Local government agencies may not use 

the provision for a restricted indirect cost rate specified in 34 CFR 76.564(c)(2). Check only one response. Leave blank, if this 

item is not applicable.

Section B - Budget Summary

Non-Federal Funds

If you are required to provide or volunteer to provide cost-sharing or matching funds or other non-Federal resources to the 

project, these should be shown for each applicable budget category on lines 1-11 of Section B.

Lines 1-11, columns (a)-(e): For each project year, for which matching funds or other contributions are provided, show the total 

contribution for each applicable budget category.

Lines 1-11, column (f): Show the multi-year total for each budget category. If non-Federal contributions are provided for only 

one year, leave this column blank.

Line 12, columns (a)-(e): Show the total matching or other contribution for each project year.
60

Line 12, column (f): Show the total amount to be contributed for all years of the multi-year project. If non-Federal 

contributions are provided for only one year, leave this space blank.

Section C - Budget Narrative [Attach separate sheet(s)]

Pay attention to applicable program specific instructions, 

if attached.

1. Provide an itemized budget breakdown, and justification by project year, for each budget category listed in Sections A and 

B. For grant projects that will be divided into two or more separately budgeted major activities or sub-projects, show for 

each budget category of a project year the breakdown of the specific expenses attributable to each sub-project or activity.

2. For non-Federal funds or resources listed in Section B that are used to meet a cost-sharing or matching requirement or 

provided as a voluntary cost-sharing or matching commitment, you must include: 

a. The specific costs or contributions by budget category; 

b. The source of the costs or contributions; and

c. In the case of third-party in-kind contributions, a description of how the value was determined for the donated or 

contributed goods or services.

[Please review ED’s general cost sharing and matching regulations, which include specific limitations, in 34 CFR 74.23, 

applicable to non-governmental entities, and 80.24, applicable to governments, and the applicable Office of Management 

and Budget (OMB) cost principles for your entity type regarding donations, capital assets, depreciation and use allowances. 

OMB cost principle circulars are available on OMB’s website at: http://www.whitehouse.gov/omb/circulars/index.html]

3. If applicable to this program, provide the rate and base on which fringe benefits are calculated.

4. If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business 

Office. Specify the estimated amount of the base to which the indirect cost rate is applied and the total indirect expense. 

Depending on the grant program to which you are applying and/or your approved Indirect Cost Rate Agreement, some 

direct cost budget categories in your grant application budget may not be included in the base and multiplied by your 

indirect cost rate. For example, you must multiply the indirect cost rates of “Training grants" (34 CFR 75.562) and grants

under programs with “Supplement not Supplant” requirements ("Restricted Rate" programs) by a “modified total direct 

cost” (MTDC) base (34 CFR 75.563 or 76.563). Please indicate which costs are included and which costs are excluded 

from the base to which the indirect cost rate is applied. 

When calculating indirect costs (line 10) for "Training grants" or grants under "Restricted Rate" programs, you must refer to 

the information and examples on ED’s website at: http://www.ed.gov/fund/grant/apply/appforms/appforms.html. 

You may also contact (202) 377-3838 for additional information regarding calculating indirect cost rates or general indirect 

cost rate information.

5. Provide other explanations or comments you deem necessary.

Paperwork Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a 

valid OMB control number. The valid OMB control number for this information collection is 1894-0008. The time required to complete this information 

collection is estimated to vary from 13 to 22 hours per response, with an average of 17.5 hours per response, including the time to review instructions, 

search existing data sources, gather the data needed, and complete and review the information collection. If you have any comments concerning the 

accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If 

you have comments or concerns regarding the status of your individual submission of this form, write directly to (insert program office), U.S. Department 

of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202. 
61

OMB Control No. 1894-0005 (Exp. 03/31/2017)

NOTICE TO ALL APPLICANTS

The purpose of this enclosure is to inform you about a new provision in the Department of Education's General Education 

Provisions Act (GEPA) that applies to applicants for new grant awards under Department programs. This provision is Section 

427 of GEPA, enacted as part of the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382).

To Whom Does This Provision Apply?

Section 427 of GEPA affects applicants for new grant awards under this program. ALL APPLICANTS FOR NEW AWARDS 

MUST INCLUDE INFORMATION IN THEIR APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER 

TO RECEIVE FUNDING UNDER THIS PROGRAM.

(If this program is a State-formula grant program, a State needs to provide this description only for projects or activities that it 

carries out with funds reserved for State-level uses. In addition, local school districts or other eligible applicants that apply to 

the State for funding need to provide this description in their applications to the State for funding. The State would be 

responsible for ensuring that the school district or other local entity has submitted a sufficient section 427 statement as described 

below.)

What Does This Provision Require?

Section 427 requires each applicant for funds (other than an individual person) to include in its application a description of the 

steps the applicant proposes to take to ensure equitable access to, and participation in, its Federally-assisted program for 

students, teachers, and other program beneficiaries with special needs. This provision allows applicants discretion in developing 

the required description. The statute highlights six types of barriers that can impede equitable access or participation: gender, 

race, national origin, color, disability, or age. Based on local circumstances, you should determine whether these or other 

barriers may prevent your students, teachers, etc. from such access or participation in, the Federally-funded project or activity. 

The description in your application of steps to be taken to overcome these barriers need not be lengthy; you may provide a clear 

and succinct description of how you plan to address those barriers that are applicable to your circumstances. In addition, the 

information may be provided in a single narrative, or, if appropriate, may be discussed in connection with related topics in the 

application.

Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to ensure that, in designing their 

projects, applicants for Federal funds address equity concerns that may affect the ability of certain potential beneficiaries to fully 

participate in the project and to achieve to high standards. Consistent with program requirements and its approved application, 

an applicant may use the Federal funds awarded to it to eliminate barriers it identifies.

What are Examples of How an Applicant Might Satisfy the Requirement of This Provision?

The following examples may help illustrate how an applicant may comply with Section 427.

(1) An applicant that proposes to carry out an adult literacy project serving, among others, adults with limited English 

proficiency, might describe in its application how it intends to distribute a brochure about the proposed project to such 

potential participants in their native language.

(2) An applicant that proposes to develop instructional materials for classroom use might describe how it will make the 

materials available on audio tape or in braille for students who are blind.

(3) An applicant that proposes to carry out a model science program for secondary students and is concerned that girls may 

be less likely than boys to enroll in the course, might indicate how it intends to conduct "outreach" efforts to girls, to 

encourage their enrollment.

We recognize that many applicants may already be implementing effective steps to ensure equity of access and participation in 

their grant programs, and we appreciate your cooperation in responding to the requirements of this provision.

 Estimated Burden Statement for GEPA Requirements

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such 

collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 1.5 

hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data 

needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain 

or retain benefit (Public Law 103-382). Send comments regarding the burden estimate or any other aspect of this collection of 

information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, 

Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1894-0005. 
62

Approved by OMB

0348-0046

Disclosure of Lobbying Activities

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden 

1. Type of Federal Action:

 a. contract

____ b. grant

 c. cooperative agreement

 d. loan

 e. loan guarantee

 f. loan insurance 

2. Status of Federal Action:

 a. bid/offer/application

 _____ b. initial award

 c. post-award 

3. Report Type:

 a. initial filing

_____ b. material change

For material change only:

Year _______ quarter _______

Date of last report___________

 

4. Name and Address of Reporting Entity:

 ____ Prime _____ Subawardee

 Tier______, if Known: 

 Congressional District, if known: 

5. If Reporting Entity in No. 4 is Subawardee, 

Enter Name and Address of Prime: 

 Congressional District, if known: 

6. Federal Department/Agency: 7. Federal Program Name/Description: 

CFDA Number, if applicable: ____________

8. Federal Action Number, if known: 9. Award Amount, if known: 

$ 

10. a. Name and Address of Lobbying Registrant

(if individual, last name, first name, MI): 

b. Individuals Performing Services (including address if 

different from No. 10a)

 (last name, first name, MI): 

11. Information requested through this form is 

authorized by title 31 U.S.C. section 1352. This 

disclosure of lobbying activities is a material 

representation of fact upon which reliance was placed 

by the tier above when this transaction was made or 

entered into. This disclosure is required pursuant to 31 

U.S.C. 1352. This information will be reported to the 

Congress semi-annually and will be available for public 

inspection. Any person who fails to file the required 

disclosure shall be subject to a civil penalty of not less 

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

failure.

Signature: __________________________________

Print Name: _____

Title: _____

Telephone No.: ____________ Date: _______

Federal Use Only Authorized for Local Reproduction

Standard Form - LLL (Rev. 7-97)
63

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at 

the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 

U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any 

lobbying entity 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 a 

covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to 

the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to 

influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a followup report caused by a material change 

to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of 

the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional 

District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to 

be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 

1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, 

State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one 

organizational level below agency name, if known. For example, Department of Transportation, United States Coast 

Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the 

full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan 

commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 

(e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the 

contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). 

Included prefixes, e.g., “RFP-DE-90-001.”

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, 

enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying 

Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). 

Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a 

valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for 

this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data 

sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management 

and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503
64

GOVERNMENT PERFORMANCE AND RESULTS ACT (GPRA)

What is GPRA?

The Government Performance and Results Act of 1993 (GPRA) is a straightforward statute that 

requires all federal agencies to manage their activities with attention to the consequences of 

those activities. Each agency is to clearly state what it intends to accomplish, identify the 

resources required, and periodically report their progress to the Congress. In so doing, it is 

expected that the GPRA will contribute to improvements in accountability for the expenditures of 

public funds, improve Congressional decision-making through more objective information on the 

effectiveness of federal programs, and promote a new government focus on results, service 

delivery, and customer satisfaction.

How has the Department of Education Responded to the GPRA Requirements?

As required by GPRA, the Department of Education has prepared a strategic plan for 2014-

2018. This plan reflects the Department’s priorities and integrates them with its mission and 

program authorities and describes how the Department will work to improve education for all 

children and adults in the U.S. The Department’s goals, as listed in the plan, are:

Goal 1: Postsecondary Education, Career and Technical Education, and Adult Education.

Increase college access, affordability, quality, and completion by improving postsecondary 

education and lifelong learning opportunities for youths and adults.

Goal 2: Elementary and Secondary Education.

Improve the elementary and secondary education system’s ability to consistently deliver 

excellent instruction aligned with rigorous academic standards while providing effective support 

services to close achievement and opportunity gaps, and ensure all students graduate high 

school college- and career-ready.

Goal 3: Early Learning.

Improve the health, social-emotional, and cognitive outcomes for all children from birth through 

3rd grade, so that all children, particularly those with high needs, are on track for graduating 

from high school college- and career-ready.

Goal 4: Equity.

Increase educational opportunities for and reduce discrimination against underserved students 

so that all students are well-positioned to succeed.

Goal 5: Continuous Improvement of the U.S. Education System.

Enhance the education system’s ability to continuously improve through better and more 

widespread use of data, research and evaluation, evidence, transparency, innovation, and 

technology.

Goal 6: U.S Department of Education Capacity.

Improve the organizational capacities of the Department to implement this strategic plan
65

What are the performance indicators for the Predominantly Black Institutions 

Program?

The performance indicators for the Predominantly Black Institutions Program are part of 

the Department’s plan for meeting Goal 1.

Program Goal: The purpose of the Predominantly Black Institutions (PBI) Program is to 

strengthen eligible institutions to plan, develop, undertake and implement programs to 

enhance the institution’s capacity to serve more low- and middle-income Black 

American students; to expand higher education opportunities for eligible students by 

encouraging college preparation and student persistence in secondary school and 

postsecondary education; and to strengthen the financial ability of the institution to 

serve the academic needs of these students.

The performance indicators for the Predominantly Black Institutions Program are:

 Enrollment Rate:

The percentage change of the number of full-time degree-seeking undergraduate 

students enrolled at PBIs. Note that this is a long-term measure, which will be 

used to periodically gauge performance.

 Persistence Rate-- four-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students at 

four-year PBIs who were in their first year of postsecondary enrollment in the 

previous year and are enrolled in the current year at the same four-year PBI. 

 Persistence Rate--two-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students at 

two-year PBIs who were in their first year of postsecondary enrollment in the 

previous year and are enrolled in the current year at the same two-year PBI.

 Completion Rate-- four-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students 

enrolled at four-year PBIs who graduate within six years of enrollment.

 Completion Rate—two-year institutions:

The percentage of first-time, full-time degree-seeking undergraduate students 

enrolled at two-year PBIs who graduate within three years of enrollment.

 Efficiency Measure:

Cost per successful program outcome: Federal cost per undergraduate degree at 

PBIs.
66

Application Transmittal Instructions

All parts of the Application for Grants under the Predominantly Black Institutions Program (CFDA No. 

84.031P) must be submitted as e-mail attachments to pbiprogram@ed.gov. 

Phase 1

Part I of the application, the Formula Elements pages, must be transmitted by March 2, 2016. The 

Formula Elements pages must be signed. The signed copy can be scanned and sent via e-mail, or faxed 

to: Predominantly Black Institutions Program, fax number (202) 502-7861. 

Phase 2

Parts II and III of the application, the Project Plan and the standard forms, certifications and surveys, must 

be transmitted by April 1, 2016. Parts II and III must also be submitted as an email attachment to 

pbiprogram@ed.gov. The signed copies of the standard forms may be scanned and sent via email, or 

faxed to: Predominantly Black Institutions Program, fax number (202) 502-7861.