OMB Number: 4040-0004

Expiration Date: 03/31/2012

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
*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.
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: 

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.

Completed by Grants.gov upon submission Completed by Grants.gov upon submission
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.]
U.S. Department of Education

Supplemental Information for the SF-424

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):

 * Email Address:

2. Novice Applicant:

 Are you are a novice applicant as defined in the regulations in 34 CFR 75.225 (and included in the 

 definitions page in the attached instructions)? 

 Yes No

3. Human Subjects Research:

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

 proposed Project Period?

Yes No

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

Yes Provide Exemption(s) # (s): 1 2 3 4 5 6 

No Provide Assurance #(s), if available:

c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to this form as indicated in 

the definitions page in the attached instructions. 

OMB Number: 1894-0007 Expiration 

Date: 07/31/2014

 
Instructions for U.S. Department of Education 

Supplemental Information for the 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. Items marked with an asterisk (*) are mandatory.

2. Novice Applicant. Check “Yes” if you meet the definition for novice applicants specified in the regulations in 34 CFR 75.225 and included 

on the attached page entitled “Definitions for U.S. Department of Education Supplemental Information for the SF-424”). By checking “Yes” 

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

This novice applicant information will be used by ED to: 1) determine the amount and type of technical assistance that a novice might need, if 

funded, and 2) determine novice applicant eligibility in discretionary grant competitions that give special consideration to novice applications. 

Certain ED discretionary grant programs give special consideration to novice applications, either by establishing a special competition for 

novice applicants or by giving competitive preference to novice applicants under the procedures in 34 CFR 75.105(c)(2). If special 

consideration is being given to novice applications under a particular discretionary grant competition, the application notice for the competition 

published in the Federal Register will specify this information

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

Information for the SF-424.”)

3a. 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.

3a. 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 

U.S. Department of Education Supplemental Information for SF-424.”) 

3b. 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. Check 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 U.S. Department of Education Supplemental Information for the SF-424.” 

3b. 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 attached page entitled 

“Definitions for U.S. Department of Education Supplemental Information for the SF-424.”

3b. Human Subjects Assurance Number. If the applicant has an approved Federal Wide Assurance (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. (A list of current FWAs is available at: http://ohrp.cit.nih.gov/search/asearch.asp#ASUR) 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.

3c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to your submission of the U.S Department of 

Education Supplemental Information for the SF-424 form as instructed in item II, “Instructions for Exempt and Nonexempt Human Subjects 

Research Narratives” in the attached page entitled “Definitions for U.S. Department of Education Supplemental Information for the SF-424.” 

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.

No covered human subjects research can be conducted until the study has ED clearance for protection of human 

subjects in research.

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, Washington, D.C. 20202-0170. 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.
Definitions for U.S. Department of Education 

Supplemental Information for the SF-424

Definitions:

Novice Applicant (See 34 CFR 75.225)

For discretionary grant programs, 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. 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 directly or indirectly linked to that 

individual, 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. If an educational practice is 

being introduced to the site and is not widely used for similar 

populations, it is not covered by this exemption.

(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. 

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. [This exemption applies only to 

retrospective studies using data collected before the initiation 

of the research.]

(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. [The standards of 

this exemption are rarely met because it was designed to apply 

only to specific research conducted by HHS at the time the 

regulations were established. We will strictly construe this 

exemption because it was not intended to apply to ED 

research.]

(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.b. of the U.S. 

Department of Education Supplemental Information for the SF 

424, the applicant must attach a human subjects “exempt 

research” or “nonexempt research” narrative to the U.S. 

Department of Education Supplemental Information for the SF424 form. 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.b. and designated exemption 

numbers(s), attach the “exempt research” narrative to the U.S.

Department of Education Supplemental Information for the SF424. 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.b. you must attach the 

“nonexempt research” narrative to the U.S. Department of 

Education Supplemental Information for the SF-424. 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.

(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 Office of the Chief Financial 

Officer, U.S. Department of Education, Washington, D.C. 

20202-4331, telephone: (202) 245-8090, 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 SF-424 in the upper 

right corner of the form (if applicable).
U.S. DEPARTMENT OF EDUCATION

BUDGET INFORMATION

NON-CONSTRUCTION PROGRAMS

OMB Control Number: 1894-

0008

Expiration Date: 04/30/2014

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

column under "Project Year 1." Applicants requesting funding for multiyear grants should complete all applicable columns. Please read all 

instructions before completing form.

SECTION A - BUDGET SUMMARY

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 _________%

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)

ED 524
Instructions for ED 524 

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 website 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.

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 nongovernmental 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. 
Additional Indirect Cost Information and Example for Training Grants 

If you are applying for a discretionary grant that the U.S. Department of Education considers to 

be a “Training grant,” your indirect cost reimbursement is limited. See the Education 

Department General Administration Regulations (EDGAR), 34 CFR 75.562, Indirect cost rates 

for educational training projects at:http://www.ed.gov/policy/fund/reg/edgarReg/edlite-part75e.html

Indirect cost reimbursement on ED training grants is limited to the grantee’s actual indirect costs as determined by 

the grantee’s negotiated indirect cost rate agreement or 8% of a modified total direct cost base, whichever is less. 

Indirect costs in excess of the 8% limit may not be charged directly, used to satisfy matching or cost-sharing 

requirements, or charged to another Federal award.

For the purposes of calculating indirect costs for training grants, EDGAR, §75.562(c), defines a modified total direct 

cost base as:

“total direct costs less stipends, tuition and related fees, and capital expenditures of $5,000 or more.”

Note: This limitation on indirect cost reimbursement for training grants does not apply to agencies of State or local 

governments, including federally recognized Indian tribal governments. However, the 8% limit applies to cost-type 

contracts under grants, if these contracts are for training as defined in EDGAR, §75.562(a).

Below is a simplified example for calculating indirect costs for a training grant using the budget categories from the 

ED 524 form, Budget Information – Non-construction Programs. The ED 524 and Instructions can be found at: 

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

For the purposes of this example, 8% of a modified total direct cost base is used to calculate indirect costs.

1. Personnel 174,000 

2. Fringe Benefits 50,000 

3. Travel 10,000 

4. Equipment 8,200 

5. Supplies 920 

6. Contractual 4,900 

7. Construction -

8. Other (Tuition) 5,400 

9. Total Direct Costs 253,420 

Calculate Modified Total Direct Cost Base

Total Direct Costs 253,420 

Less:

Equipment 8,200 

Tuition 5,400 

 13,600 

Modified Total Direct Cost Base: 239,820 

Multiply $239,820 by 8%: 19,186 

10. Indirect Costs 19,186 

11. Training Stipends 6,300 

12. Total Costs 278,906
Additional Indirect Cost Information and Example for Grants under Restricted Rate Programs 

If you are applying for a grant from the U.S. Department of Education (ED) under a Restricted Rate Program that is 

subject to a statutory “supplement not supplant” restriction, you are required to use a restricted indirect cost rate. 

See the Education Department General Administrative Regulations (EDGAR), 34 CFR 75.563 [discretionary 

grants] at http://www.ed.gov/policy/fund/reg/edgarReg/edlite-part75e.html or 34 CFR 76.563 [formula grants] at 

http://www.ed.gov/policy/fund/reg/edgarReg/edlite-part76f.html, as applicable, and 34 CFR 76.564 through 76.569 

at http://www.ed.gov/policy/fund/reg/edgarReg/edlite-part76f.html.

Restricted rates for State Educational Agencies (SEA) are included on the SEA’s negotiated indirect cost rate 

agreement. Restricted rates for Local Educational Agencies are provided by the SEA, using a method approved by 

ED. The restricted rate requirements also apply to any subgrants from the prime recipient.

All applicants must use the restricted rate included on their negotiated indirect cost rate agreement. Applicants for 

discretionary grants that are not a State or Local government and do not have a negotiated restricted rate, may use 

the 8% rate described at §76.564(c )(2). If an applicant’s calculated restricted rate is less than 8%, the lower rate 

must be used for the application’s budget. The 8% rate in §76.564(c)(2) must also be multiplied by the modified 

total direct cost base described in §76.569.

For grants under Restricted Rate Programs, §76.569 requires that grantees multiply their restricted indirect cost rate 

by:

“Total direct costs of the grant minus capital outlays, subgrants, and other distorting or unallowable items as 

specified in the grantee's indirect cost rate agreement.” 

Commonly, such a procedure is referred to as multiplying by a modified total direct cost base. 

Below is a simplified example for calculating indirect costs for a Restricted Rate program using budget categories 

from the ED 524 form, Budget Information – Non-Construction Programs. The ED 524 and Instructions can be 

found at: http://www.ed.gov/fund/grant/apply/appforms/appforms.html

For the purposes of this example, a 6% restricted rate from a negotiated indirect cost rate agreement is used to 

calculate indirect costs.

1. Personnel 150,000 

2. Fringe Benefits 50,000 

3. Travel 10,000 

4. Equipment 5,400 

5. Supplies 600 

6. Contractual 3,700 

7. Construction -

8. Other (tuition) 72,000 

9. Total Direct Costs 291,700 

Calculate Modified Total Direct Cost Base

Total Direct Costs 291,700 

Less:

Equipment 5,400 

Tuition 72,000 

 77,400 

Modified Total Direct Cost Base: 214,300 

Multiply $214,300 by 6% restricted rate: 12,858 
10. Indirect Costs (using 6% restricted rate) 12,858

11. Training Stipends -

12. Total Costs 304,558

OMB Control No. 1894-0005 (Exp. 03/31/2014)

NOTICE TO ALL APPLICANTS
Previous Edition Usable Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction Prescribed by OMB Circular A-102

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 Federallyfunded 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.
Previous Edition Usable Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction Prescribed by OMB Circular A-102

 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. 

Electronic Notification Option for Grant Awards

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 e-mail containing a link to access G5, the 

Department’s Grant Management System. The email will be sent to both the project director and 

certifying representative in order for them to view and print the Adobe Acrobat version of the 

electronically signed GAN. If neither the project director nor certifying representative is registered in G5, 

they will immediately be prompted to register once the link is accessed. The electronic signature and 

issuance of the GAN makes it crucial that your application include correct email addresses for both 

the project director and certifying representative. 
Previous Edition Usable Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction Prescribed by OMB Circular A-102

CERTIFICATION REGARDING LOBBYING 

Certification for Contracts, Grants, Loans, and Cooperative Agreements 

The undersigned certifies, to the best of his or her knowledge and belief, that: 

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any 

person for influencing or attempting to influence an officer or employee of an agency, a Member of 

Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with 

the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the 

entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or 

modification of any Federal contract, grant, loan, or cooperative agreement. 

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for 

influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an 

officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal 

contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard 

Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions. 

(3) The undersigned shall require that the language of this certification be included in the award documents 

for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and 

cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification 

is a material representation of fact upon which reliance was placed when this transaction was made or 

entered into. Submission of this certification is a prerequisite for making or entering into this transaction 

imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be 

subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 

Statement for Loan Guarantees and Loan Insurance 

The undersigned states, to the best of his or her knowledge and belief, that: 

If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer 

or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of 

a Member of Congress in connection with this commitment providing for the United States to insure or 

guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying 

Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or 

entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the 

required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 

for each such failure. 
Previous Edition Usable Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction Prescribed by OMB Circular A-102

Certification of Eligibility for Federal Assistance in Certain Programs

I understand that 34 CFR 75.60, 75.61, and 75.62 require that I make specific certifications of eligibility to the U.S. Department of Education 

(ED) as a condition of applying for Federal funds in certain programs and that these requirements are in addition to any other eligibility 

requirements that ED imposes under program regulations. Under 34 CFR 75.60 – 75.62:

I. I certify that:

A. I do not owe a debt, or I am current in repaying a debt, or I am not in default (as that term is used at 34 CFR Part 668) on a 

debt:

1. To the Federal Government under a nonprocurement transaction (e.g., a previous loan, scholarship, grant, or cooperative 

agreement); or

2. For a fellowship, scholarship, stipend, discretionary grant, or loan in any program of ED that is subject to 34 CFR 75.60, 

75.61, and 75.62, including: 

 Federal Pell Grant Program (20 U.S.C. 1070a, et seq.);

 Federal Supplemental Educational Opportunity Grant (SEOG) Program (20 U.S.C. 1070(b), et seq.):

 State Student Incentive Grant Program (SSIG) 20 U.S.C. 1070c, et seq.);

 Federal Perkins Loan Program (20 U.S.C. 1087aa, et seq.);

 Income Contingent Direct Loan Demonstration Project (20 U.S.C. 1087a, note);

 Federal Stafford Loan Program, Federal Supplemental Loans for Students [SLS], Federal PLUS, or Federal 

Consolidation Loan Program (20 U.S.C. 1071, et seq.);

 William D. Ford Federal Direct Loan Program (20 U.S.C. 1087a, et. seq.);

 Cuban Student Loan Program (20 U.S.C. 2601, et seq.);

 Robert C. Byrd Honors Scholarship Program (20 U.S.C. 1070d-31, et seq.);

 Jacob K. Javits Fellows Program (20 U.S.C. 1134h-1134l);

 Patricia Roberts Harris Fellowship Program (20 U.S.C. 1134d-1134g);

 Christa McAuliffe Fellowship Program (20 U.S.C. 1105-1105i);

 Bilingual Education Fellowship Program (20 U.S.C. 3221-3262);

 Rehabilitation Long-Term Training Program (29 U.S.C. 774(b));

 Paul Douglas Teacher Scholarship Program (20 U.S.C. 1104, et seq.);

 Law Enforcement Education Program (42 U.S.C. 3775);

 Indian Fellowship Program (29 U.S.C. 774(b));

 Teacher Quality Enhancement Grants Program (20 U.S.C. 1021, et seq.);

OR

B. I have made arrangements satisfactory to ED to repay a debt as described in A.1. or A.2. (above) on which I had not been 

current in repaying or on which I was in default (as that term is used in 34 CFR Part 668).

II. I certify also that I have not been declared by a judge, as a condition of sentencing under section 5301 of the Anti-Drug Abuse Act 

of 1988 (21 U.S.C. 862), ineligible to receive Federal assistance for the period of this requested funding.

I understand that providing a false certification to any of the statements above makes me liable for repayment to ED for funds received on the 

basis of this certification, for civil penalties, and for criminal prosecution under 18 U.S.C. 1001.

____________________________________________ ____________________________________ 

 (Signature) (Date)
Previous Edition Usable Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction Prescribed by OMB Circular A-102

____________________________________________

 (Typed or Printed Name)

Name or number of ED program under which this certification is being made: _____________________________ 

ED 80-0016 (Revised 2/01)

OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS

Public reporting burden for this collection of information is estimated to average 15 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 (0348-0040), Washington, DC 20503

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND 

BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding 

agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, 

you will be notified.

As the duly authorized representative of the applicant I certify that the applicant:

1. Has the legal authority to apply for Federal assistance, and 

the institutional, managerial and financial capability 

(including funds sufficient to pay the non-Federal share of 

project cost) to ensure proper planning, management, and 

completion of the project described in this application.

2. Will give the awarding agency, the Comptroller General of 

the United States, and if appropriate, the State, through any

authorized representative, access to and the right to examine 

all records, books, papers, or documents related to the award; 

and will establish a proper accounting system in accordance 

with generally accepted accounting standards or agency 

directives.

3. Will establish safeguards to prohibit employees from using 

their positions for a purpose that constitutes or presents the 

appearance of personal or organizational conflict of interest, 

or personal gain.

4. Will initiate and complete the work within the applicable 

time frame after receipt of approval of the awarding agency.

5. Will comply with the Intergovernmental Personnel Act of 

1970 (42 U.S.C. 4728-4763) relating to prescribed 

standards for merit systems for programs funded under one of 

the 19 statutes or regulations specified in Appendix A of 

OPM's Standards for a Merit System of Personnel 

Administration (5 C.F.R. 900, Subpart F).

6. Will comply with all Federal statutes relating to 

nondiscrimination. These include but are not limited to: (a) 

Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which 

prohibits discrimination on the basis of race, color or national 

origin; (b) Title IX of the Education Amendments of 1972, as 

amended (20 U.S.C. 1681-1683, and 1685-1686), which 

prohibits discrimination on the basis of sex; (c) Section 504 

of the Rehabilitation Act of 1973, as amended (29 U.S.C. 

794), which prohibits discrimination on the basis of

handicaps; (d) the Age Discrimination Act of 1975, as 

amended (42 U.S.C.  6101-6107), which prohibits 

discrimination on the basis of age; (e) the Drug Abuse Office 

and Treatment Act of 1972 (P.L. 92-255), as amended, 

relating to nondiscrimination on the basis of drug abuse; (f) 

the Comprehensive Alcohol Abuse and Alcoholism 

Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 

91-616), as amended, relating to nondiscrimination on the 

basis of alcohol abuse or alcoholism; (g)  523 and 527 of

the Public Health Service Act of 1912 (42 U.S.C.  290 dd-3 
and 290 ee 3), as amended, relating to confidentiality of 

alcohol and drug abuse patient records; (h) Title VIII of the 

Civil Rights Act of 1968 (42 U.S.C.  3601 et seq.), as 

amended, relating to nondiscrimination in the sale, rental or 

financing of housing; (i) any other nondiscrimination 

provisions in the specific statute(s) under which application 

for Federal assistance is being made; and (j) the requirements 

of any other nondiscrimination statute(s) which may apply to 

the application.

7. Will comply, or has already complied, with the requirements 

of Titles II and III of the uniform Relocation Assistance and 

Real Property Acquisition Policies Act of 1970 (P.L. 91-646) 

which provide for fair and equitable treatment of persons 

displaced or whose property is acquired as a result of Federal 

or federally assisted programs. These requirements apply to 

all interests in real property acquired for project purposes 

regardless of Federal participation in purchases.

8. Will comply, as applicable, with the provisions of the Hatch 

Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the 

political activities of employees whose principal employment 

activities are funded in whole or in part with Federal funds.

9. Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act 

(40 U.S.C. 276c and 18 U.S.C. 874) and the Contract 

Work Hours and Safety Standards Act (40 U.S.C.  327-

333), regarding labor standards for federally assisted 

construction subagreements.

10. Will comply, if applicable, with flood insurance purchase 

requirements of Section 102(a) of the Flood Disaster 

Protection Act of 1973 (P.L. 93-234) which requires 

recipients in a special flood hazard area to participate in the 

program and to purchase flood insurance if the total cost of

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

 

11. Will comply with environmental standards which may be 

prescribed pursuant to the following: (a) institution of

environmental quality control measures under the National 

Environmental Policy Act of 1969 (P.L. 91-190) and 

Executive Order (EO) 11514; (b) notification of violating 

facilities pursuant to EO 11738; (c) protection of wetlands 

pursuant to EO 11990; (d) evaluation of flood hazards in 

floodplains in accordance with EO 11988; (e) assurance of 

project consistency with the approved State management 

program developed under the Coastal Zone Management Act 

of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of Federal 

actions to State (Clear Air) Implementation Plans under 

Section 176(c) of the Clear Air Act of 1955, as amended (42 

U.S.C. 7401 et seq.); (g) protection of underground 

sources of drinking water under the Safe Drinking Water Act 

of 1974, as amended, (P.L. 93-523); and (h) protection of

endangered species under the Endangered Species Act of

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

12 Will comply with the Wild and Scenic Rivers Act of 1968 

(16 U.S.C. 1721 et seq.) related to protecting components 

or potential components of the national wild and scenic rivers 

system.

13. Will assist the awarding agency in assuring compliance with 

Section 106 of the National Historic Preservation Act of 

1966, as amended (16 U.S.C. 470), EO 11593 (identification 

and protection of historic properties), and the Archaeological 

and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et 

seq.).

14. Will comply with P.L. 93-348 regarding the protection of

human subjects involved in research, development, and 

related activities supported by this award of assistance. 

15. Will comply with the Laboratory Animal Welfare Act of

1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) 

pertaining to the care, handling, and treatment of warm 

blooded animals held for research, teaching, or other 

activities supported by this award of assistance.

16. Will comply with the Lead-Based Paint Poisoning Prevention 

Act (42 U.S.C. 4801 et seq.) which prohibits the use of

lead- based paint in construction or rehabilitation of 

residence structures.

17. Will cause to be performed the required financial and 

compliance audits in accordance with the Single Audit Act 

Amendments of 1996 and OMB Circular No. A-133, 

Audits of States, Local Governments, and Non-Profit 

Organizations.

18. Will comply with all applicable requirements of all other 

Federal laws, executive orders, regulations and policies 

governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

APPLICANT ORGANIZATION DATE SUBMITTED

Standard Form 424B (Rev. 7-97) Back
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 disclosure)

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)
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