# AmeriCorps State and National **Insert name of Grant Competition**
**DRAFT APPLICATION INSTRUCTIONS**  **State and National Competitiv e**  **New and Continuation**  **I ncluding**  **: As**  **applicable to the Notice of Funding Opportunity or Notice of Funding Availability** 

**OMB Control #: Expiration Date:** 

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**IMPORTA NT NOTICE**  These application instructions conform to the Corporation for National and Community Service’s online grant application system, eGrants . All funding announcements by the Corporation for National and Community Service (CNCS) are posted on www.nationalservice.gov and www.grants.gov . **Public Burden Statem ent:**  Public reporting burden for this collection of informat ion is estimated to average 40 hours per submission, including reviewing instructions, gathering and maintaining the data needed, and completing the form. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 1201 New York Avenue, NW, Washington, D.C. 20525. CNCS informs people who may respond to this collection of information that they are not required to respond to the collection of information unless the OMB control number and expiration date displayed on page one are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) **Privacy Act Notice:** The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to yo u: The information requested on the Ame riCorps Application Instructions is collected pursuant to 42 U.S.C. §§ 12581 - 12585 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. § 4953 of the Domestic Volunteer Service Act of 1973 as amended. Purposes and Uses - The information requested is collected for the purposes of reviewing grant applications and granting funding requests. Routine Uses - Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. In some programs, the information may also be provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. The information may also be provided to appropriate federal agencies and Department contractors that have a need to know the information for the purpose of assisting the Department’s efforts to respond to a suspected or confirmed breach of the se curity or confidentiality or information maintained in this system of records, and the information disclosed is relevant and unnecessary for the assistance. Executive Summaries of all compliant applications received and applications of successful applicant s will be published on the CNCS website as part of ongoing efforts to increase transparency in grantmaking. This is described in more detail in the Notice of Federal Funding Opportunity. The information will not otherwise be disclosed to entities outside o f AmeriCorps and CNCS without prior w ritten permission. Effects of Nondisclosure - The information requested is mandatory in order to receive benefits. **Federal Funding Accountability and Transparency Act:** Grant recipients will be required to report at www.FSRS.gov on all subawards over $25,000 and may be required to report on executive compensation for recipients and subrecipients. Recipients must have the necessary systems in place to colle ct and report this information. See 2 C.F.R. Part 170 for more information and to determine how these requirements apply. **Universal Identifier:** Applications must include a Dun and Bradstreet Data Universal Numbering System (DUNS) number and register with the Central Contractor’s Registry (CCR). All grant recipients are required to maintain a valid registration, which must be renewed annually.

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**TA BLE OF CONTENTS**  Im portant Notice ................................ ................................ ................................ ................................ ............................ 2 **Application Resources ................................**  **................................ ................................**  **................................ .................**  **4 Submitting Your**  **Application in eGrants ................................**  **................................ ................................**  **.................. 4**  I. Applicant Info ................................ ................................ ................................ ................................ .............. 5 II. Application Info ................................ ................................ ................................ ................................ ........... 5 III. Narratives ................................ ................................ ................................ ................................ ..................... 6 IV. Performance Measures ................................ ................................ ................................ ................................ . 7 V. Documents ................................ ................................ ................................ ................................ ................... 8 VI. Budget Instructions ................................ ................................ ................................ ................................ .... 10 VII. Revie w, Authorize, and Submit ................................ ................................ ................................ ................. 11 VIII **. Continuation Requests**  **................................ ................................**  **................................ .............................**  **1 2**  **Tables** Table 1: Requirements in the AmeriCorps Regulations ................................ ................................ ............................... 4 Table 2: Match Requirements in the AmeriCorps Regulations ................................ ................................ .................. 1 0 

### ATTACHMENTS **These Attachments are Worksheets only. All information must be entered in eGrants.** A. SF - 424 Facesheet (eGrants Applicant Info and Application Info Sections) ................................ ........................ 18 B . Performance Measure Instructions for New/Recompeting Applicants (eGrants Performance Measures Section) . 19 C. Performance Measure Instructions for Continuation Applicants(eGrants Performance Measures Section) ........... 22 D . Detailed Budget Instructions ................................ ................................ ................................ ................................ . 2 6 E . Budget Worksheet ................................ ................................ ................................ ................................ ................ 3 1 F . Detailed Budget Instructions for Fixed - Amount Grants ................................ ................................ ....................... 3 5 G . Fixed - Amo unt Budget Worksheet ................................ ................................ ................................ ........................ 3 7 H . Budget Checklist ................................ ................................ ................................ ................................ .................. 3 8 I . Alternative Match Instructions ................................ ................................ ................................ ............................. 4 0 J . Beale Codes and County - Level Economic Data ................................ ................................ ................................ ... 4 1 K . Assurances and Certifications (eGrants Authorize and Submit Section) ................................ ............................. 4 3 L . Benefic i ary

Populations /Grant Characteristics (eGrants Performance Measures Section) ... ... .... . .. ............ ... . 5 0

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**AP PLICA** **TION RESOURCE S**  Please use these application instructions if you are a new or recompeting applicant . If you are submitting a request for continuation, please see the Continuation Instructions which begin on page 1 2 . Use these instructions in conjunction with the Notice of Federal Funding Opportunity (Notice) , and the AmeriCorps Regulations, 45 CFR §§ 2520

–2550. **The Notice**  **includes deadlines, eligibility requirements, submission requirements, maximum** **amount of funding per Member Service Year (MSY 1**  **), and other inform ation that**  **is sp**  **ecific to the grant competition .**  The AmeriCorps regulations include pertinent information (see Table 1, below). The Notice can be found at http://www.americorps.org/for_organizations/funding/nofa.asp . The full regulations are available online at www.gpoaccess.gov/ecfr . **Table 1: Requirements in the Am eriCorps Regulations**  Topics Citation in the AmeriCorps Regulations Mem ber Service Activities §2520.20 - §2520.55 Prohibited Activities §2520.65 Tutoring Programs §2522.900 - 2522.950 Matching Funds §2521.35 - 2521.90 Mem ber Benefits §2522.240 - 2522.250 Calculating Cost Per Member Service Year (MSY) §2522.485 Performance Measures §2522.500 - 2522.650 Evaluation §2522.500 - 2522.540 and §2522.700 - 2522.740 Selection Criteria and Selection Process §2522.400 - 2522.475 If there is any inconsistency between the AmeriCorps regulations, the Notice, and the Application Instructions, the or der of precedence is as follows: 1. AmeriCorps regulations 45 CFR §§ 2520

–2550 take precedence over the 2. Notice of Federal Funding Opportunity /Notice of Federal Funding Availability , wh ich takes precedence over the 3. Application Instructions. **SUBMITTING YOUR A PPLICA**  **TION IN EGRA NTS**  **New and R e**  **competing Applicants** New applicants need to establish an eGrants account by accessing this link: https://egrants.cns.gov/espan/main/login.jsp and selecting “Don’t have an eGrants account? Create an account.” In eGrants, before Starting Section I you will need to:  Start a new Grant Application  Select a Program Area (AmeriCorps)  Select a NOFA (see the Notice for a listing) Your application consi sts of the following components. M ake sure to complete each section. I. Applicant Info II. Application Info 1 One MSY is equivalent to at least 1700 service hours, a full - time AmeriCorps position. The CNCS cost per MSY is determined by dividing the CNCS share of budgeted grant costs by the number of MSYs request ed in the application . It does not include childcare or the cost of the education award.

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III. Narratives IV. Performance Measures V. Documents VI. Budget VII. Revie w, Authorize, and Submit

### 6 **I. Ap**  **plicant Info** Information entered in the Applicant Info, Application Info, and Budget sections will populate the SF 424 Facesheet. **If you are submitting your application in hard copy, you will find the SF 424 in Attachment A.**


###  If you are recompeting (in the final year of a competitive funding cycle and applying for a new grant cycle ), select **Continuation/Renewal**



###  If you are applying for the first time and have never had an AmeriCorps State or National grant , select **New** 

###  If you are a current planning grantee applying for an im plementation grant, select **New** 

###  If you are a previous Grantee that has been funded through state formula grants and/or were an unsuccessful recompete applicant in previous years, select **Previous** . Enter or update the requested information in the fields that appear. The contact person needs to be the person who can answer questions about the application. **II . A**  **pplication Info**  In the Application Info Section enter:  Areas affected by your proposed program. Please include the two - letter abbreviation with both letters capitalized for each state where you plan to operate. Separate each two - letter state abbreviation with a comma. For city or county information, please follow each one with the two - letter capitalized state abbreviation.  Requested project p eriod start and end dates. The length of the project period is specified in the Notice .  Indicate Yes or No i f you are delinquent on any federal debt. If yes, send explanation as described in Section V.D.  State Application Identifier: Enter N/A.  The Application is Subject to Revie w by State Executive Order 12372 Process : This is pre - filled as “No, this is not applicable.”  If you plan to request a waiver of the volunteer leveraging requirement please select “Request a waiver” at the bottom of the scr een. A pop - up screen will appear. Select a waiver type and enter your volunteer leveraging waiver request justification in the narrative field in 2,000 characters or less.  Total Match. Enter the total dollar amount of match being proposed.  Total Private Match. Enter the dollar amount of private match being proposed. The “Total Private Match” + the “T otal Local, State, and Federal Government Match” should equal the “Total Match.”  Total Local, State, and Federal Government Match. Enter the dollar amount of local, state, and federal government match being proposed. The “Total Private Match” + the “Total Local, State, and Federal Government Match” should equal the “Total Match.”  Leveraged funds. Enter the amount of funds that your program uses to run the program that are not CNCS share or match.  Leveraged funds source. Enter the sources/investors of the leveraged funds.  Number of Episodic Volunteers Generated by AmeriCorps members. Please enter the number of volunteers that will be parti cipating in one day se rvice projects that the proposed AmeriCorps members will generate.  Number of Ongoing Volunteers Generated by AmeriCorps members. Please enter the number of volunteers that have an ongoing volunteer commitment that the proposed AmeriCorps members will gene rate.  Leave the box for “Program Initiative” blank unless otherwise noted in the Notice .  The “Estimated Funds Requested” box will be populated automatically after you complete the budget.  Multi - State Operating Sites. Please fill in the following informati on for your operating sites: organization name, city, and state , amount of funding going to the operating site, number of proposed AmeriCorps members that will be located at the site.  Opt in to the National Service Registry .  AmeriCorps Identity/Co - branding. Check all the boxes that apply.

### 7 **III. Narratives** The narrative section of the application is your opportunity to convince reviewers that your project meets the selection criteria as outlined in the Notice . Below are some general rec omme ndations to help you present your project in a way

the reviewers will find compelling and persuasive.  **Lead from your program** **strengths and be explicit.** Do not make the mistake of trying to stretch yo ur proposed program description to fit each funding p riority and special consideration articulated in the regulations or the Notice.  **Be clear and succinct.** Reviewers are not interested in jargon, boilerplate, rhetoric, or exaggeration. They are interested in learning precisely what you intend to do, and how yo ur project responds to the selection criteria presented below .  **Avoid circular reasoning.** The problem you describe should not be defined as the lack of the solution yo u are proposing.  **Explain how.** Avoid simply stating that the criteria will be met. Expli citly describe how the proposed project will meet the criteria.  **Don’t m ak** **e assumptions.** Even if you have received funding from CNCS in the past, do not assume yo ur reviewers know

anything about you, your proposed program, your partners, or your beneficiari es. Avoid overuse of acronyms.  **Use an impartial proofreader.** Before you submit your application, let someone who is completely unfamiliar with your project read and critique the project narrative.  **Follow the instructions and discuss each criterion in the o rder they are presented in the**  **instructions.** Use headings to differentiate narrative sections by criteri on . In eGrants, you will enter text for  Executive Summary.  Rationale and Approach ( Program Design) .  Organizational Capability.  Cost Effectiveness and Budget Adequacy.  Evaluation Plan. Note: T he Narratives Section also includes fields for Clarification Information, Amendment Justification, and Continuation Changes. **Please enter N/A in these fields. They will be used**  **at a later d ate**  **to enter inform ation**  **for clarification following review, to**  **request am endments once a grant is awarded, and**  **to enter changes in the**  **narrative in continuation requests.** Revie wers will assess your application against the selection criteria. To best res pond to the criteria listed in the N otice and Application Instructions , we suggest that you include a brief discussion of each bullet if it pertains to yo ur application. **A. Executive Summary** Please complete the executive summary per the guidance in the N otice . **B. Selection Criteria** Each application must clearly describe a project that will effectively deploy AmeriCorps members to solve a significant community problem. Specifics about the selection criteria are published in the Notice. **1. Rationale and**  **Approach / Program Design**  **(50 percent)** In assessing Rationale and Approach/ Program Design , reviewers will examine the degree to w hich the applicant demonstrates how AmeriCorps members are particularly well - suited to solving the identified community problem .

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**2. Organizational Capability (25 percent)**  Revie wers will assess the extent to which the applicant demonstrates organizational background and staffing, sustainability, compliance and accountability, enrollment and retention (for current and former grante es), consultation with State Commissions(not required for Indian Tribes), and operating and member service sites ( as indicated in the Notice .) 

### 3. **Cost Effectiveness and Budget Adequacy (25 percent)** In assessing Cost Effectiveness and Budget Adequacy, reviewers will examine the degree to w hich the intervention being proposed is cost effective and the budget is appropriate for the program being proposed. **C. Evaluation Summary or Plan** If you are comp eting for the first time, please enter N/A in the Evaluation Summary or Plan field since it pertains only to recompeting grantees. If you are recompeting for AmeriCorps funds for the first time please follow the guidance in the Notice . **D. Am endment Justi**  **fication** Enter N/A. This field will be used if you are awarded a grant and need to amend it. **E. Clarification Inform ation**  Enter N/A. This field will be used to enter information that requires clarification in the post - revie w period. Please clearly label new information added during clarification with the date. **F. Continuation Changes** Enter N/A. This field will be used to enter changes in your narratives in your continuation requests. **IV . Perform**  **ance Measures**  Applicants must check the relevant boxes in the Performance Measure tab in eGrants in order to be considered for CNCS’ assessment of the strategic considerations and Special Initiatives . Grant Characteristics:  AmeriCorps member Population

– Communities of Color  AmeriCorps member Population

– Lo w - income individuals  AmeriCorps member Population

– Native Americans  AmeriCorps member Population

– New Americans  AmeriCorps member Population

– Older Americans  AmeriCorps member Population

– People with Disabilities  AmeriCorps member Population

– Rural Residents  AmeriCorps member Population

– Veterans, Active Military , or their Families  AmeriCorps member Population

– Economically disadvantaged young adults/Opportunity Youth  AmeriCorps member Population

– None of the above  Geographic Focus

– Rural  Geograp hic Focus

– Urban  Encore Program  Faith organizations  Community - based organizations,  Governor and Mayor Initiative  SIG/Priority Schools  Professional Corps  21 st CSC  Other  Percentage of MSYs in Tier 1 Performance Measures  Percentage of MSYs in Tier 2 Performance Measures

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All applicants must submit performance measures with their application. See Attachment B for instructions for entering performance measures . For more information about Performance Measures go to: http://www.nationalserviceresources.org/star/ac For more information about the National Performance Measures go to: http://www.nationalserviceresources.org/national - performance - measures/home . **V. Documents** In addition to the application submitted in eGrants, you are required to provide your evaluation, labor union concurrence (if necessary

– see B., below) a federally - approved indirect cost agreement (if applicable and as indicated in the Notice ), and other required documents listed in the N otice (if applicable) via the e - mail listed in the N otice , as part of your application. After you have submitted the documents, change their status in eGrants from the default “Not Sent” to the applicable status “Sent,” “Not Applicable,” or “Already on File at CNCS . ” **A. Evaluation** Submit any completed evaluation plan or report as described in E ., below . Select Evaluation and select “Sent” once yo u have submitted a completed evaluation plan or report . If an evaluation is required, you must submit a copy at the time of application even if you think CNCS may already have it on file. **B. Labor Union Concurrence** 1) If a program applicant: a) Proposes to serve as the placement site for AmeriCorps members; and b) Has employees engaged in the same or substantially similar work as that proposed to be carried out by AmeriCorps members; and c) Those employees are represented by a local labor organization, then the application must include the written concurrence of the local labor organizatio n representing those employees. Written concurrence can be in the form of a letter or e - mail from the local union leadership. 2) If a program applicant: a) Proposes to place AmeriCorps members at sites where they will be engaged in the same or substantially sim ilar work as employees represented by a local labor organization, then the applicant must submit a w

ritten description of how it will ensure that : i) AmeriCorps members won’t be placed in positions that were recently occupied by paid staff . ii) No AmeriCorps mem ber will be placed into a position for which a recently resigned or discharged em ployee has recall rights as a result of a collective bargaining agreement, from which a recently resigned or discharged employee was removed as a result of a reduction in forc e, or from which a recently resigned/discharged employee is on leave or strike. For the purposes of this section, “program applicant” includes any applicant to CNCS or a State Commission, as well as any entity applying for assistance or approved nation al service positions through a CNCS grantee or subgrantee. If either 1) or 2) above applies to you, please select “Enter New ,” name the ne w document 1) “Labor Union Concurrence,” or 2) “Displacement Assurance” and select “Sent.” **C. Federally -**  **approved Indirect Cost Agreem**  **ent** Applicants applying directly to CNCS that include a federally approved indirect cost rate amount in their budget must submit the approved indirect cost rate agreement to americorpsgrants@cns.gov at the same time they submit their application.

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**D. Other Docum ents**  Provide other required documents listed in the Notice (if applicable) via the email listed in the Notice , as part of your application. **E .**  **Delinquent on Federal Debt**  Any applicant that check s Yes to the question on federal debt delinquency must submit a complete explanation. **F . Submission Instructions for Evaluations, Labor Union Concurrence**  **, Indirect Cost Rate Agreem**  **ents , and**  **Other Required Documents** Please submit the required documents to the email listed in the N otice with the subject line of the name of your organization and the application ID number . This information must be received at CNCS by the deadline in the N otice .

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**VI. Budget Instructions**  **For Fixed -**  **Am ount grants, including EAPs:**  **Use the Budget Instructions for Fixed -**  **Am ount applicants**  **(Attachm ent**  **F ) and**  **the Budget Worksheet (** **Attachment G** **) to prepare your budget.**  **A. Match Requirements**  Program requirements, including requirements on match are located in the AmeriCorps regulations and summarized below . **Table 2: Match Requirem ents in the AmeriCorps Regulations**  **Grant Type Match Requirement**  Cost Reimbursement including Professional Corps, States and Territories without Commissions, Indian Tribes Minimum grantee share is 24% of program costs for the first three years. Overall grantee share of total program costs increases gradually beginning in Year 4 to 50% by the tenth year of funding an d any year thereafter **.** EAP Fixed - amount Grants There are no specific match requirements for fixed amount grants. Grantees pay all program costs over $800 per MSY provided by CNCS . Professional Corps Fixed - amount Grants There are no specific match requirements for fixed amount grants. Grantees pay all program costs over the $2,000 per MSY provided by CNCS . Full - Time Fixed - amo unt Grants There are no specific match requirements for full - time F ixed - amount grants. Grantees pay all program costs over the ma ximum $13,000 p er MSY provided by CNCS .  Grantees are required to meet an overall matching rate that increases over time. You have the flexibility to meet the overall match requirements in any of the three budget areas, as long as the minimum match of 24% for the first three years, and the increasing minimums in years thereafter, are maintained. See 45 CFR §§ 2521.35

– 2521.90 for the specific regulations.  If you are applying for the first time, you must match with cash or in - kind contributions at least 24% of the project’s total Operating Costs (Section I) plus Member Costs (Section II) plus Administrative Costs (Section III). If you are recompeting, please see 45 CFR §§ 2521.40 - 2521.95 for the match schedule.  The acceptable sources of matching funds are federal, state, local, private sector, and/or other funds in accordance with applicable AmeriCorps requirements.  In Section III of the budget, enter a brief description of the source of match . I dentify each match source separately. Include dollar amount , the match classification (cash, in - kind, or Not Available) and the source type ( P rivate, State/Local, F ederal , Other or Not Available) . Define all acronyms the first time they are used.  See Attachment I for instructions for applying for the Alternative Match Schedule. Note : The CNCS l egislation permits the use of non - CNCS federal funds as match for the grantee share of the budget. Please discuss your intention of using federal funds to match an AmeriCorps grant with the other agency prior to submitting your application. Section 121(e)(5) of the National Community Service A ct requires that grantees that use other federal funds as match for an AmeriCorps grant report the amount and source of these funds to CNCS . If you use other federal funds as match, you must ensure you can meet the requirements and purpose of both grants. The Federal Financial Report (FFR) will be used to collect the federal match data. Grantee s that use federal funds as match will be required to report the sources and amounts on the FFR. **B. Preparing Your Budget**  Your proposed budget should be sufficient to allow you to perform the tasks described in your narrative. Reviewers will consider the information you provide in this section in their assessment of the Cost - Effectiveness and Budget Adequacy selection criterion. Follow the detailed budget instruc tions in Attachment D to prepare your budget. We recommend that you prepare yo ur budget in the same order as indicated in the Budget Worksheets in Attachments D and E .

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As you enter your detailed budget information, eGrants will automatically populate a b udget summary and budget narrative report. Prior to submission be sure to review the budget checklist (Attachment H ) to ensure your budget is compliant. In addition, eGrants will perform a limited compliance check to validate the budget. If it finds any co mp liance issues you will receive a warning and/or error messages. You must resolve all errors before you can submit your budget. As you prepare your budget:  All the amounts you request must be defined for a particular purpose. Do not include miscellaneous , contingency, or other undefined budget amounts.  Itemize each cost and present the basis for all calculations in the form of an equation.  Do not include unallowable expenses, e.g., entertainment costs (which include food and beverage costs) unless they ar e justified as an essential component of an activity.  Do not include fractional amounts (cents). Please refer to the relevant OMB Circulars on allowable costs for further guidance. The OMB circulars are online at www. whitehouse.gov/OMB/circulars.  A - 21 - Cost Principles for Educational Institutions, 2 CFR 220  A - 87 - Cost Principles for State, Local, and Indian Tribal Governments, 2 CFR 225  A - 122 - Cost Principles for Non Profit Organizations, 2 CFR 230 Programs must comply with all applicable federal law s, regulations, and OMB circulars for grant management, allowable costs, and audits, including providing audits to the A - 133 clearinghouse if expending over $500,000 in federal funds, as required in OMB C ircular A - 133. **VII. Review, A**  **uthorize, and Submit** eGrants requires that you review and verify your entire application before submitting, by completing the following sections in eGrants: 

###  Revie w 

###  Authorize 

###  Assurances 

###  Certifications 

###  Verify 

###  Submit Read the Authorization, Assurances, and Certifications carefully (Attachment K). The person who authorizes the application must be the applicant’s Authorized Representative or his/her designee and must have an active eGrants account to sign these documents electronic ally. An Authorized Representative is the person in your organization authorized to accept and commit funds on behalf of the organization. A copy of the governing body’s authorization for this official representative to sign must be on file in the applicant’s office. Be sure to check your entire application to ensure that there are no errors before submitting it. eGrants will also generate a list of errors if there are sections that need to be corrected prior to submission when you verify the application. If someone else is acting in the role of the applicant’s authorized representative, that person must log into his/her eGrants account and proceed with Authorize and Submit. After signing off on the Authorization, Assurances, and Certifications, his/her nam e will override any previous signatory that may appear and show on the application as the Authorized Representative. **Note: Anyone within your organization who will be entering information in the application at any point during application preparation and**  **submission in the eGrants system must have their own eGrants account.** Individuals may establish an eGrants account by accessing this link: https: //egrants.cns.gov/espan/main/login.jsp and selecting “Don’t have an eGrants account? Create an account.”

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**CONTINUA TION REQUEST**  **S** The following instructions for submitting a continuation request apply only to programs that are currently in their first or second year of operation within a grant cycle. If your program is currently in the final year of its grant cycle, yo u must apply using the application instructions for new and recompeting programs. In addition, if you are in year two or three of a cost - rei mb ursement grant cycle , you need to submit a new application to participate in the fixed amount grant ; you cannot continue your existing project period and switch from cost - reim bursement to fixed amount. CNCS reserves the right to consider your continuatio n request if your fixed - amount application is not funded. **When to Submit Your Continuation Request:** See the Notice for application deadlines . **How to Subm it Your Continuation Request:**   Submit your continuation request in eGrants.  C lick **Continuation/Renew al**  on your eGrants home page. You will be shown a list of grants that are eligible to be continued. Select the grant you wish to continue. **Mak e sure you select the correct one. Do not start a new**  **application.** The system will copy your most recently awarded application.  Edit your continuation application as directed in the continuation request instructions below. When you have completed your work, click the **SUBMIT** button. Be sure you also review the Notice when preparing your request. If you have question s about the content of your continuation request, please contact your Program Officer. **What to Include in Your Continuation Request: I. Applicant Info and Application Info**  Update the Applicant Info and Application Info Sections in eGrants if necessary. Note in the Continuation Changes field that you have updated the Applicant Info or Application Info Section(s). **Ap plication Info**  In the Application Info Section enter:  Areas affected by your proposed program. Please include the two - letter abbreviation with both letters capitalized for each state where you plan to operate. Separate each two - letter state abbreviation with a comma. For city or county information, please follow each one with the two - letter capitalized state abbreviation.  Requested project p eriod start and end dates.  Indicate Yes or No if you are delinquent on any federal debt. If yes, send explanation as described in Section V.D.  State Application Identifier: Enter N/A.  The Application is Subject to Revie w by State Executive Order 12372 Process: This is pre - filled as “No, this is not applicable.”  If you plan to request a waiver of the volunteer leveraging requirement please select “Request a waiver” at the bottom of the screen. A pop - up screen will appear. Select a waiver type and enter your volunteer leveraging waiver request justification in the narrative field in 2,000 characters or less.  Leave the box for “Program Initiative” blank unless otherwise noted in the Notic e .  The “Estimated Funds Requested” box will be populated automatically after you complete the budget.  Total Match. Enter the total dollar amount of match being proposed.  Total Private Match. Enter the dollar amount of private match being proposed. The “To tal Private Match” + the “T otal Local, State, and Federal Government Match” should equal the “Total Match.”  Total Local, State, and Federal Government Match. Enter the dollar amount of local, state, and federal government match being proposed. The “Total Private Match” + the “Total Local, State, and Federal Government Match” should equal the “Total Match.”

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 Leveraged funds. Enter the amount of funds that your program uses to run the program that are not CNCS share or match.  Leveraged funds source. Enter the sources/investors of the leveraged funds.  Number of Episodic Volunteers Generated by AmeriCorps members. Please enter the number of volunteers that will be parti cipating in one day service projects that the proposed AmeriCorps members will generate.  Numb er of Ongoing Volunteers Generated by AmeriCorps members. Please enter the number of volunteers that have an ongoing volunteer commitment that the proposed AmeriCorps members will generate.  Multi - State Operating Sites. Please fill in the following inform ation for your operating sites: organization name, city, and state , amount of funding going to the operating site, number of proposed AmeriCorps members that will be located at the site.  Opt in to the National Service Registry .  AmeriCorps Identity/Co - branding. Check all boxes that apply. **II. Narrative (Narratives Section)** Your original application will appear in the Executive Summary and in the narrative sections Rationale and Approach, Organizational Capability, Cost - Effectiveness and Bud get Adequacy, Evaluation Summary or Plan, Amendment Justification, Clarification Information, and Continuation Changes, as appropriate. **Do not enter continuation changes in the original narrative fields.** If you are not proposing changes to your continuation request, simply leave your original narrative as it is, and enter No Changes in the Continuation Changes field. **If you have changes in any of these areas, please document them in the Continuation Changes field in**  **eGrants.** Clearly differentiate Year 2 and Year 3 continuation changes by using headings that label these as such. Continuation changes may include, but are not limited to:  New site locations.  E xpansion to new sites, including the need that will be met in expansion communities, activities of expansion members, and organizational capacity to support the expansion.  Any changes in the budget.  Any increase in requested cost per MSY . **T his applies even if the increased cost per MSY is less than the**  **ma ximu**  **m or if the increase is due to increased cost s set by**  **CNCS .**   Any changes in your expected sources of revenue beyond CNCS funds. **Plans for improving enrollment, retention, or other com pliance issues.**  If you enrolled less than 100% of slots received during your last full year of program operation, prov ide an explanation, and describe your plan for im provement in the Continuation Changes field. If you were not able to retain all of your members during your last full year of program operation, provide an explanation, and describe your plan for improveme nt in the Continuation Changes field. We recognize retention rates may vary among equally effective programs depending on the program model. We expect grantees to pursue the highest retention rate possible. If you are requesting to conduct new activities or additional MSYs, these also need to be reflected in the budget and the performance measures. The page limit for the Continuation Changes field is 6 pages, as the pages print out from eGrants. **In the Continuation Changes field,** d escribe the manner and extent to which you consulted with the State Commission in the states in which you plan to operate (not applicable to Tribes) . **III. Perform**  **ance Measures (Perform ance Measures Section**  **)** Applicants must check the relevant boxes in the Performance Measure tab in eGrants. Grant Characteristics:  AmeriCorps member Population

– Communities of Color

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 AmeriCorps member Population

– Lo w - income individuals  AmeriCorps member Population

– Native Ame ricans  AmeriCorps member Population

– New Americans  AmeriCorps member Population

– Older Americans  AmeriCorps member Population

– People with Disabilities  AmeriCorps member Population

– Rural Residents  AmeriCorps member Population

– Veterans, Active Military , or their Families  AmeriCorps member Population

– Economically disadvantaged young adults/Opportunity Youth  AmeriCorps member Population

– None of the above  Geographic Focus

– Rural  Geographic Focus

– Urban  Encore Program  Faith - and community - based organizations  Governor and Mayor Initiative  SIG/Priority Schools  Professional Corps  21 st CSC  Other  Percentage of MSYs in Tier 1 Performance Measures  Percentage of MSYs in Tier 2 Performance Measures Your performance measures are copied from your previous year’s application into your continuation request. If you made changes to your program, such as adding or changing grant - funded activities, or requesting additional slots or MSYs, you may need to revi se your performance measures, To revise performance measures, “ View/Edit ” the performance measures that copy over from your original application, or add new performance measures. Note in the Continuation Changes field that you have updated your performance measures. **IV . Budget**  **(Budget Section )**  Your budget from the previous year ’s application is copied into your continuation request so you can make the necessary adjustments. Revise your detailed budget for the upcoming year. Incorporate any required CNCS increases, such as an increase to the member living allowance into your budg et. Justify any increases not required by CNCS . CNCS expects that the Cost per MSY for continuation applicants will decrease or remain the same. Any increase in Cost per MSY must be justified in the Continuation Changes field. **Source of Match** In the “Sour ce of Match” field that appears at the end of Budget Section III , enter a description of the Source of Match, the amount, the match classification (Cash, In - kind, or Not Available) and Match Source (State/Local, Federal, Private, Other) **for your entire m at**  **ch.** Define any acronyms the first time they are used. Enter each match source separately. **V. Increasing Grantee Overall Share of Total Budgeted Costs**  Grantees are required to meet an overall matching rate that increases over time. You have the flexibility to meet the overall match requirements in any of the three budget areas, as long as the minimum match of 24% for the first three years, and the increasing minimums in years thereafter, are maintained. See 45 CFR §§ 2521.35

–2521.90 for the speci fic regulations. See Attachment I for instructions for applying for the Alternative Match Schedule.

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**AT TA**  **CHMENT A:**  **Facesheet Instructions (eGrants A**  **pplicant Info and A pplication Info Sections)**  Modified Standard Form 424 (Rev. 11/02 to conform to eGrants ) This form is required for applications submitted for federal assistance. **Item #** 1. Filled in for your convenience. 2. Self

- explanatory. 3. 3. a. and 3. b. are for state use only (if applicable). 4. Item

4. a: Leave blank. Item 4. b: If you are a recipient in year 2 or 3 of an already - aw arded grant, enter the grant number, otherwise, leave blank. 5. Enter the following information: a. The complete name of the organization that will be legally responsible for the grant, not the name of th e organizational unit within the legally responsible organization. (For example, indicate “National University” instead of “Liberal Arts Department.”) b. Your organization’s DUNS number (received from Dun and Bradstreet). **This is a required field. Please s**  **ee the Notice for instructions on how to obtain a DUNS number.** c. The name of the primary organizational unit that will undertake the assistance activity, if different from 5. a. d. Your organization’s complete address with the 9 digit ZIP+ 4 code. e. Th e name and contact information of the project director or other person to contact on matters related to this application. 6. Enter your Employer Identification Number (EIN) as assigned by the Internal Revenue Service. 7. Item

7. a.: Enter the appropriate letter in the box. Item 7. b.: Please enter the characteristic(s) that best describe your organization. **K -**  **12 Education Non**  **- Profit Organizations**  1 School (K - 12) 11 Community - Based Organization 2 Local Education Agency 12 Faith - Based Organization 3 State Education Agency 13 Chamber of Commerce/ Business Association 14 Community Action Agency/ Program **Higher Education** 15 Service/Civic Organization 4 Vocational/Technical College 16 Volunteer Management Organization 5 Community College 17 Self - Incorporated Senior Corps Project 6 2 - year College 18 Statewide Association 7 4 - year College 19 National Non - Profit (Multistate) 8 Hispanic Serving College or University 20 Local Affiliate of National Organization 9 Historically Black College or University 21 Tribal Organization (Non - government) 10 Tribally Controlled College or University 22 Other Native American Organization **Government** 23 Local Government - Municipal 28 Other State Government 24 Health Department 29 Tribal Government Entity 25 Law Enforcement Agency 30 Area Agency on Aging 26 Governor’s Office U.S. Territory 27 State Commission/Alternative Administrative Entity

### 17

8. Check the appropriate box for type of application and enter the appropriate letter(s) in the lower boxes: 

###  If you are recompeting (in year three of a competitive three - year funding cycle and applying for a new three - year grant), select **Continuation/Renewal** 

###  If you are applying for the first time and have never had an AmeriCorps State or National grant, select **New** 

###  If you are a current planning grantee applying for a three - year implementation grant, select **New** 

###  If you are a previous Grantee that has been funded through state formula grants and/or were an unsuccessful recompete applicant in previous years, select **Previous** . 9. Filled in for your convenience. 10. Use the following list of CFDA (Catalog of Federa l Domestic Assistance) numbers for the applicable program listing, or other source if so instructed in the Notice : 94.006 AmeriCorps State and National. 11. Enter the project title. a. When applying for a “Continuation” or “Amendment” applicants shoul d use the same title as used for their existing grant program. When applying as a “New Applicant/Previous Grantee” if the application is for re - funding of a previous grant program, use the same title as was used in the prior grant program if appropriate ( i.e., if the program is unchanged). b. Enter the name of the program initiative, if any, as provided in the instructions corresponding to the Notice for which you are applying; otherwise, leave blank. 12. List only the largest political entities affected (e.g., counties, and cities) . Please include the two - letter abbreviation with both letters capitalized for each state where you plan to operate. Separate each two letter state abbreviation with a comma. For city or county information, please follow each on e with the two - letter capitalized state abbreviation. 13. (See item 8) Enter the dates for the proposed project period. “Continuation” or “Amendment” application: Enter the dates of the approved project period. Performance Period: this appears only in eGrants, and is for the use of staff only. 14. Leave blank, staff use only. 15. Estimated Funding. Check the appropriate box to indicate the grant year for which funding is being requested. Enter the amount requested or to be contributed **during this budget period**  on each appropriate line, as shown below. The value of in - kind contributions should be included in these amounts, as applicable. For revisions (See item 8), if the action will result in a dollar change to an existing a ward, include **only** the amount of the change. For decreases, enclose the amounts in parentheses. **a. Federal**  The total amount of federal funds being requested in the budget. **b. Applicant**  The total amount of the applicant share as entered in the budget. **a. State**  The amount of the applicant share that is coming from state sources. **d. Local**  The amount of the applicant share that is coming from local governmental sources

(e.g., city, county and other municipal sources). **e. Other** The amount of the applicant share that is coming from non - governmental sources. **f. Program Income**  The amount of the applicant share that is coming from income generated by

programmatic activities (i.e., use of the additive option where program income is used to increase the size of the program). **g. Total** The applicant's estimate of the total funding amount for the agreement. 16. Pre - filled for your convenience. This program is excluded from coverage by Executive Order 12372.

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17. Check the appropriate box. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of debt include delinquent audit allowances, loans, and taxes. If Yes, attach an explanation. 18. The person w

ho signs this form must be the app licant’s authorized representative. A copy of the governing body’s authorization for this official representative to sign must be on file in the applicant’s office. **Note: Falsification or concealm**  **ent of a m aterial fact, or subm** **ission of false, fictitio us or fraudulent**  **statem ents or representations to any departm**  **ent or agency of the United States Government may result in a fine of not m**  **ore than $10,000 or im prisonment for not m**  **ore than five (5) years, or both. (18 U.S.C. § 1001)** 

### 19 **APPLICATION FOR FEDERAL ASSISTANCE** Standard Form 424 (Rev. 2 - 2007) Prescribed by OMB Circular **1. TYPE OF**  **SUBMISSION: 2. a. DATE**  **SUBMITTED: 3. a. DATE RECEIVED**  **BY STATE:** 3. b. STATE APPLICATION IDENTIFIER: 2. b. APPLICATION **4. a. DATE RECEIVED BY FEDERAL AGENCY:**  4. b. FEDERAL IDENTIFIER: (Staff Only) **5. APPLICANT INFORMATION** 5. a. LEGAL NAME: 5. b. ORGANIZATIONAL DUNS: 5. c. ORGANIZATIONAL UNIT 5. e. NAME AND TELEPHONE NUMBER OF PERSON TO BE CONTACTED ON MATTE RS INVOLVING THIS APPLICATION (give 5. d. ADDRESS (give street address, city, county, state and zip code): STREET: CITY: COUNTY: STATE: COUNTRY: NAME: TELEPHONE NUMBER: ( ) - FAX NUMBER: ( ) - EMAIL: INTERNET E - MAI L ADDRESS: WEBSITE:

**6. EMPLOYER IDENTIFICATION NUMBER (EIN):**  **7. a. TYPE OF APPLICANT: ( enter**  **appropriate letter in box)** A. State H. Independent School District B. County I. State Controlled Institution of Higher Learning C. Municipal J. Private University D. Township K. Indian Tribe E. Interstate L. Individual F. Intermunicipal M. Profit Organization G. Special District N. Private Non - Profit Organization O. Federal Government P. HQ Internal Organizations Q. State Education Agency R. Territory S. Other (specify) 7. b. CNCS APPLICANT CHARACTERISTICS Enter appropriate codes: **8. TYPE OF APPLICATION** NEW NEW/PREVIOUS GRANTEE CONTINUATION REVISION If Revision, enter appropriate letter(s) in box(es): A. AUGMENTATION B. BUDGET REVISION: C. NO COST EXTENSION to (enter date) E. OTHER (specify below) **9. NAME OF FEDERAL AGENCY:**  Corporation for National and Community Service **10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE**  **NUMBER: 11. a. DESCRIPTIVE TITLE OF APPLICANT’S**  **PROJECT:**
**12. AREAS AFFECTED BY PROJECT**  **(List Cities, Counties, States, etc.):**  11.b. CNCS PROGRAM INITIATIVE (IF ANY):
**13. PROPOSED PROJECT:** START DATE: ENDING DATE: **14. Performance Period (Staff Use Only_ 15. ESTIMATED FUNDING:**  Check applicable box: Yr 1: Yr.2: Yr. **16. IS**  **APPLICATION SUBJECT**  **TO REVIEW**  **BY STATE**  **EXECUTIVE ORDER 12372 PROCESS**  ? a. Y ES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE

TO THE STATE EXECUTIVE ORDER 12372 PROCESSS FOR REVIEW ON:

DATE ___________________________________ b. NO. PROGRAM IS NOT COVERED BY E.O. 12372 a. FEDERAL $ b. APPLICANT $ c. STATE $ d. LOCAL $ e. OTHER $ f. PROGRAM INCOME $ g. TOTAL $ **18. TO**  **THE BEST**  **OF MY**  **KNOWLEDGE AND**  **BELIEF, ALL**  **DATA IN**  **THIS APPLICATION/PREAPPLICATION**  **ARE TRUE**  **AND CORRECT,**  **THE DOCUMENT**  **HAS BEEN DULY**  **AUTHORIZED BY**  **THE GOVERNING**  **BODY OF**  **THE APPLICANT**  **AND THE**  **APPLICANT WILL**  **COMPLY WITH**  **THE ATTACHED**  **ASSURANCES IF**  **THE ASSISTANCE IS AWARDED.**  a. TYPED NAME OF AUTHORIZED REPRESENTATIVE: b. TITLE: c. TELEPHONE NUMBER: d. SIGNATURE OF AUTHORIZED REPRESENTATIVE: e. DATE SIGNED:

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**AT TA**  **CHMENT B**  **: Performance Measures Instructions for New/Recompeting**  **Ap plicants**  **(eGrants Performance Measures Section) eGrants Perform**  **ance Measures Module Instructions About the Perform**  **ance Measures Module** In the performance measures module, you will:  Provide information about your program’s connection to CNCS focus areas and objectives.  Show MSY and slot allocations.  Create one or more aligned performance measure.  Set targets and describe data collection plans for your performance measures. **Hom e Page**  To start the module, click the “Begin” button on the Home Page . As you proceed through the module, the Home Page will summarize your work and provide links to edit the parts of the module you have completed. You may also navigate sections of the module using the tab feature at the top of each page. Once you have started the module, clicking “Continue Working” will return you to the tab you were on when you last closed the module. To edit the interventions, objectives, MSYs, and slot allocations for your application, click the “Edit Objectives/MSYs/Slots” button. After you have created at least one aligned performance measure, the Home Page will display a chart summarizing yo ur measures. To edit a performance measure, click the “ E dit” button. To d elete a measure, click “ D elete.” To create a new

performance measure, click the “Add New Performance Measure” button. **Objectives Tab** An expandable list of CNCS focus areas appears on this tab. When you click on a focus area, a list of objectives from the CNCS strategic plan appears. A list of common interventions appears under each objective. First click on a focus area. Then click on an objective and select all interventions that are part of your program design. Interventions are the activities that members and volunteers will carry out to address the problem(s) identified in the application. Select “other” if one of your program’s interventions does not appear on the list. Repeat these actions for each of your program’s focus areas. Select “other” for your focus area and/or objective if yo ur program activities do not fall within one of the CNCS focus areas or objectives. Choose your program’s primary focus area from the drop - down list. Only the focus areas that correspond to the objectives yo u selected above appear in the list. Next, select the primary intervention within your primary focus area. You will be required to create an aligned performance measure that contains yo ur primary intervention. You may select a secondary focus area an d a secondary intervention. The primary and secondary focus area may be the same if you have more than one intervention within the focus area. **MSYs/Slots Tab** On this tab, you will enter information about the allocation of MSYs and slots across the focus areas and objectives yo u have selected. Begin by entering the total MSYs for your program .

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Next, enter the number of MSYs your program will allocate to each objective. Only the objectives that were selected on the previous tab appear in the MSY chart. If some of your program’s objectives are not represented in the chart, return to the previous tab and select additional objectives. The MSY chart must show how all your program’s resources are allocated. As you enter MSYs into the MSY column of the chart, the corresponding percentage of MSYs will calculate automatically. When you have finished entering your MSYs , the total percent age of MSYs in the chart must be 100 %. The total number of MSYs in the chart must equal the number of MSYs in your budget (+/ - 1 MSY). In the slots column , enter the number of me mbers that will be assigned to each objective. Some members may perform services across more than one objective. If this is the case, allocate these members ’ slots to all applicable objectives. For example, if one member works on both school readiness and K - 12 success, allocate one slot to each of these objectives. It is acceptable for slots in this table to exceed total slots requested in the application due to double counting members’ service across multiple objectives. **Perform ance Measure Tab**  This tab allow s you to create sets of aligned performance measures for all the grant activities you intend to measure. You must create at least one aligned perfo rmance measure that includes your primary intervention. You may create additional aligned performance measures. To create an aligned performance measure, begin by selecting an objective. The list of objectives includes those you selected on the objectiv es tab. Provide a short, descriptive title for your performance measure. Briefly describe the problem your program will address in this performance measure. Select the intervention(s) to be delivered by members and member - supported volunteers. The list of interventions includes the ones you selected previously for this objective. Select only the interventions that will lead to the outcomes of this aligned performance measure. If you selected “other” as an intervention and wish to include an applicant - determined intervention in your aligned performance measure, click “add user intervention” and enter a one or two word description of the intervention. Select output(s) for your aligned performance measure. The output list includes only the National Perf ormance Measure outputs that correspond to the objectives you have selected. If you do not wish to select National Performance Measures, you may create an applicant - determined output by clicking “Add User Output.” Select outcome(s). If you have selec ted a National Performance Measures output with a corresponding National Performance Measures outcome, these outcomes will be available to select. If you have not selected a National Performance Measures output, or if there is no corresponding outcome, cr eate an applicant - determined outcome by clicking “Add User Outcome.” For Capacity Building National Performance Measures, you may select optional end outcomes. Complete the corresponding drop - dow

n box for any end outcome selected. Enter the number of MS Ys and slots your program will allocate to achieving the outcomes you have selected in this performance measure. Since programs are not required to measure all grant activities, the number you enter does not have to correspond to the MSY chart you created on the MSY/Slots tab; however, the total number of MSYs across all performance measures within a single objective cannot exceed the total number of MSYs previously allocated to that objective. Slots may be double - counted across performance measures, but MSYs may not. Click “next” to proceed to the data collection tab. Later you can return to this tab to create additional aligned performance measures.

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**Data Collection Tab** On this tab, you will provide additional information about your interventions, instruments and plan for data collection. Describe the design and dosage (frequency, intensity, duration) of the interventions you have selected. Expand each output and outcome and enter data collection information. Select the data collection method you will use to measure the output or outcome. Describe the specific instrument(s) you will use to measure the output or outcome. Include the title of the instrument(s), a brief description of what it measures and how it will be administered, and details about its reliability and validity if applicable. Enter the target number for your output or outcome. Targets must be numbers, not percents. For applicant - determined outputs and outcomes, enter the unit of measure for your target. The unit of measure s hould describe the population you intend to count (children, miles, etc.). Do not enter percents or member hours as units of measure. After entering data collection information for all outputs and outcomes, click “ Mark Complete. ” You will return to the Performance Measure tab. If you wish to create another performance measure, repeat the process. If you would like to continue to the next step of the module, click “Next.” **Summary Tab** The summary tab shows all of the information you have entered in the mo dule. To print a summary of all performance measures, click “Print PDF for all Performance Measures.” To print one performance measure, expand the measure and click “Print This Measure.” Click “Edit Performance Measure ” to return to the Performance M easure tab. Click “Edit Data Collection” to return to the Data Collection tab. “Click Validate Performance Measures” to validate this module prior to submitting your application.

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**ATTACHMENT C: Performance Measures Instructions for Continuation Applicants (eGrants Performance Measures Section)**  **Am eriCorps Performance Measures**  To begin entering performance measures, from your eGrants grant application page select Performance Measures. **All applicants must complete Steps 1 -**  **6. Then, if you are:** 

###  Entering applicant - determined performance measures, follow steps 7A - 18A. 

###  Opting in to the National Performance Measures, follow steps 7B - 17B. **Step 1: Select Characteristics.** To begin, click one or more boxes in the “Grant Characteristics” **Step 2: Select Focus Areas** Select the Focus Area in which your primary service activity fits. You m ay also select “Capacity Building” if this is a significant area of member activity. If your primary service activity does not fit into a Focus Area, select “Other” and skip to **Step 5** . You may select multiple Focus Areas to represent significant areas of AmeriCorps member activity. Do not include multiple Focus Areas to describe the same activity. Select the Focus Area that best describes the activity. **Step 3: Choose whether to Opt -**  **in to National Perform ance Measures:**  When you select a Focus Area, eGrants automatically pre - populates the selection “No” in response to the question “Will you be using a national performance measure related to this Focus Area?”


###  Leave this selection as “No” if you do not want to participate in the National Performance Me asures for that Focus Area.


###  Change the selection to “Yes” if you want to opt - in to the National Performance Measures for that Focus Area. You must consult the “National Performance Measures Instructions” to determine which performance measures are approp riate for your program: http://www.americorps.gov/for_organizations/funding/nofa_detail.asp?tbl_nofa_id=91 . You may also find resources at this link to be h elpful: http://www.nationalserviceresources.org/national - performance - measures/home If you selected “Other” as your only Focus Area, you will skip this step as there are no National Performance Measures for “Other”. **Step 4: Com plete the MSY Chart(s)**  Fo r each Focus Area selected, complete a Member Service Years (MSY) Chart. If you have selected Capacity Building or Other, complete an MSY Chart for these selections as well. Click the “view/edit MSY Slots” orange link. There are two sets of numbers to ent er in each MSY Chart. First, for each slot type, enter the number of members that will be providing service in that Focus Area. Second, enter the percent of time that members of each slot type will spend on activities in that Focus Area. Use whole numbers to represent the percent. Do not use a % or a decimal. (For example, for 100 percent, type “100.”) eGrants will calculate the total MSYs for each slot type, then aggregate the MSYs for the entire chart in the “Total MSYs Devoted to Priority” field at the bottom of the chart. Note that MSYs in each category should be mutually exclusive. Do not double count MSYs. The total MSYs across all Focus Areas, Capacity Building, and Other should not exceed the total MSYs requested in the budget.

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**Step 5: Add a Serv ice Category**  For each Focus Area selected above, as well as Capacity Building and Other, you must select a Primary Service Category. Click the “Add a Service Category” orange link. Select your Focus Area from the drop - dow n menu and click “Go.” Select your Service Category from the options provided in the pop - up menu. The Service Category you select will determine the Indicator drop - down options in later steps. If this is the first or only Service Category you select, eGrants will automatically check “ Primary” to indicate this is yo ur primary activity. To select more than one Service Category, simply click the “add a service category” link. Only one Service Category should be indicated as the primary per Focus Area. You may add additional service catego ries if appropriate for your program design. Additional service categories may be labeled as “Secondary.” **Step 6: Add a Perform ance Measure**  You must create at least one aligned set of Performance Measures representing your Primary Service Activity, which is achieved through either National Performance Measures or applicant - determined performance measures. An aligned measure includes an output and an outcome. If you have opted - in to National Performance Measures, you will see the links for both “add a n ational performance measure” and “add an applicant performance measure.” If you have not opted - in to National Performance Measures, you will only see the link for “add an applicant performance measure.”

Choose National Performance Measures or Applicant - Pe rformance Measures


###  Follow

the instructions **7A**
**– 17A for**  each aligned set of applicant - determined measures yo u need to create.


###  Follow

the instructions for **7B**
**– 17B**  for each aligned set of national performance measures you need to create. **Applicant Perform**  **ance Measures Step 7A: Add a Perform**  **ance Measure** Follow the instructions for **7A**
**– 18A**  for each applicant - determined performance measure you will create. Begin by creating the Performance Measure Output and then repeat steps 13A - 18A to create an ali gned Intermediate Outcome. **Step 8A: Select a Focus Area** The Focus Area drop - down box will consist of all the focus areas that were initially select ed in the main Focus Area section. **Step 9A Add Perform ance Measure Title**  Give this performance measure a title

— usually 3 - 4 words that describe the activity

— and enter it in the text box. **Step 10A: Select a Service Category** Service Category is a drop - down menu of choices based on your earlier identification of Service Categories; select one and continue by pr essing the “go” button **Step 11A: Describe Strategies to Achieve Result** Briefly describe the intervention that will lead to the outcome you are proposing. Keep statements to one or two paragraphs with a maximum of 500 characters. **Step 12A: Select a Result Type**  You will need to select the Result T ype that you intend to track for this activity

– output or intermediate outcome

– and click “Add New Results Section.” You should begin each aligned measure with the selection of an Output Measure.

### 25

**Step 13A: Write a Result Statem**  **ent** Enter 1 - 2 sentences stating the expected output or outcome. **Step 14A: Select an Indicator** Select an Indicator from the drop - down menu. If the options provided do not include the Indicator you are measuring, select “other” and describe the Indicator in the text box that will appear. **Step 15A: Write a Target Description** In 250 characters or less, include a description of the target. Be sure to include how you determine what is counted in this target. For example: 100 parents will atten d the eight - we ek parenting skills/drop out prevention class. **Step 16A: Select a Target Number or Percent** Write the number from your target statement in the Target box and indicate whether it is a whole number or percent **Step 17A: Identify your Instruments**  Describe the Instruments that will be used to measure your output/outcome in 250 characters or less. These are specific tools to collect information such as a behavior checklist, tally sheet, attitude questionnaire, or intervie w protocol. **Ste p 18A: Write a Perform**  **ance Measure Statem ent**  Provide the expected result and target combined into one or two sentences in 1,000 characters or less. Once you have completed the output performance measurement information, do the same for your intermediate o utcome and/or additional measures, if necessary. Begin by identifying the Result T ype as “intermediate outcome” and complete Steps 13A through 18A again. If you would like to enter an “end outcome”, you may do so by completing Steps 13A through 18A again. End outcomes are not required. **National Perform ance Measures**  Follow the instructions for **7B**
**– 17B**  for each aligned set of National Performance Measures you need to create. You will use these instructions to complete measures if you have opted in to Nation al Performance Measures for any Focus Area. Please refer to National Performance Measures Instructions for complete instructions for aligning measures. 

###  If you select the Education Focus Area and opt - in to National Performance Measures, you are only allowe d to select National Performance Measures.


###  If you select the Disaster Services, Economic Opportunity, Environmental Stewardship, Healthy Futures , or Veterans Focus Areas, or Capacity Building, and opt - in to National Performance Measures, you will enter your National Performance Measures. If you choose, you may add additional, applicant - determined Measures after yo u enter the National Performance Measures. **Step 7B: Add a National Perform ance Measure**  Click the “add a national performance measures” orange link. Then select the Focus Area. Only those Focus Areas that were checked as participating in the National Performance Measures will be displayed. **Step 8B: Add a Perform ance Measurem**  **ent Title** Give this performance measure a title

— usually 3 - 4 words that describe the activity

— and enter it in the text box. Continue by pressing the “go” button.

### 26

**Step 9B: Describe Strategies to Achieve Result** Brief ly describe the intervention that will lead to the outcome you are proposing. Keep statements to one or two paragraphs with a maximum of 500 characters. **Step 10B: Select a Result Type** You will need to select the Result T ype that you intend to track for th is activity

– output or intermediate outcome

– and click “Add New Results Section.” You should begin each aligned measure with the selection of an Output Measure. **Step 11B: Select the Indicator** This is where you select your National Performance Measure. Th ere is a drop - down list containing the National Performance Measures for the Focus Areas that you have selected. Once you select your first National Performance Measure, eGrants will provide onscreen instructions about other National Performance Measures you must use in conjunction with this measure or if you need to add an applicant determined intermediate outcome. If you need to add an applicant - determined intermediate outcome measure, you will select “Other” from the pop - up list. **Step 12B: Write Resul t Statement**  Enter 1 - 2 sentences stating the expected output or outcome. **Step 13B Write a Target Description** In 250 characters or less, include a description of the target. Be sure to include how you determine what is counted in this target. For example: 1 00 parents will attend the eight - week parenting skills/drop - out prevention class. **Step 14B: Select a Target Number** Write the number in the Target box from your target description. You are only allowed to use a number. **Step 15B: Identify your Instruments** Describe the Instruments that will be used to measure your output/outcome in 250 characters or less. These are specific tools to collect information such as a behavior checklist, tally sheet, attitude questionnaire, or intervie w protocol. Check for guidanc e on appropriate instruments posted at the National Performance Measures resource page: http://nationalserviceresources.org/national - performance - measures/home **Step 16B: Write a Perform ance Measures Statem**  **ent** Provide the expected result and target combined into one or two sentences (1,000 characters or less). **Step 17B: Create Aligned Measure** After completing the output performance measurement information, do the same for your intermediate outcome. Begin by identifying the Result Type, and then complete Ste ps **11B to 16B** again. Once you complete entering an aligned measure as defined by the National Performance Measure, you will return to Step 7 and create any other aligned measures to report member activities in Focus Areas or other areas of service either by : 

###  **Following Steps 7A**
**– 18A for an applicant**  **- determined measure or** 


###  **Following Steps 7B**
**– 17B for an aligned National Performance Measure.** 

### 27

**AT TA**  **CHMENT D**  **: Detailed Budget Instructions (eGrants Budget Section) Section I. Program** **Operating Costs** Com plete Section I, Program Operating Costs, of the Budget Worksheet by entering the “Total Amount,” “CNCS Share,” and “Grantee Share” for Parts A - I, for Year 1 of the grant, as follows: **A. Personnel Expenses** Under “Position/Title Description,” list each staff position separately and provide salary and percentage of effort as percentage of FTE devoted to this award. Each staff person’s role listed in the budget must be described in the application narrative and each staff person mentioned in the narrative must be listed in the budget as either CNCS or Grantee share. Because the purpose of this grant is to enable and stimulate volunteer community service, do not include the value of direct community service perfo rmed by volunteers. However, you may include the value of volunteer services contributed to the organization for organizational functions such as accounting, audit work, or training of staff and AmeriCorps members. **B. Personnel Fringe Benefits** Under “Pur

pose/Description,” identify the types of fringe benefits to be covered and the costs of benefit(s) for each staff position. Allowable fringe benefits typically include FICA, Worker’s Compensation, Retirement, SUT A, Health and Life Insurance, IRA, and 401K. You may provide a calculation for total benefits as a percentage of the salaries to which they apply or list each benefit as a separate item. If a fringe benefit amount is over 30%, please list covered items separately and justify the high cost . Holidays, leave, and other similar vacation benefits are not included in the fringe benefit rates , but are absorbed into the personnel expenses (salary) budget line item. **C. 1. Staff Travel** Describe the purpose for which program staff will travel. Provide a calc ulation that includes itemized costs for airfare, transportation, lodging, per diem, and other travel - related expenses multiplied by the number of trips/staff. Where applicable, identify the current standard reimbursement rate(s) of the organization for mi leage, daily per diem , and similar supporting information. Reim bursement should not exceed the federal mileage rate unless a result of applicant policy and justified in the budget narrative. Only domestic travel is allowable. **We expect all State Commissio**  **ns and National Direct applicants to include funds in this line ite**  **m for travel**  **for staff and site staff to attend CNCS**  **- sponsored technical assistance meetings. There are two to three such**  **opportunities per year, including the Financial Management Institut**  **e and the Annual Grantee Meeting in**  **Washington ,**  **DC in the fall** . Please itemize the costs. For example: T wo staff members will attend the Annual Grantee Meeting in Washington, DC . 2 staff X $750 airfare + $50 ground transportation + (1 day) X $400 lodging + $35 per diem = $2,470 for Annual Grantee Meeting . **C. 2. Mem ber Travel**  Describe the purpose for which members will travel. Provide a calculation that includes itemized costs for airfare, transportation, lodging, per diem, and other related expenses for members to travel outside their service location or between sites. Costs associated with local travel, such as bus passes to local sites, mileage reimbursement for use of car, etc. , should be included in this budget category. Where applicable, identify the current standard reimbursement rate(s) of the organization for mileage, daily per diem, and similar supporting information. **D. Equipment** Equipment is defined as tangible, non - e xpendable personal property having a useful life of more than one year AND an acquisition cost of **$5,000 or m ore**  **per unit** (including accessories, attachments, and modifications). Any items that do not meet this definition should be entered in E. Supplies b elow . Purchases of equipment are limited to 10% of the total CNCS funds requested. If applicable, show the unit cost and number of units you are requesting. Provide a brief justification for the purchase of the equipment under Item/Purpose.

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**E. Supplies** AmeriCorps members must wear an AmeriCorps logo on a daily basis

– preferabl y clothing with the AmeriCorps logo. T he item with the AmeriCorps logo is a required budget expense. Ple ase include the cost of the item with the AmeriCorps logo in your budget or e xplain how your pr ogram

w ill be providing the item to AmeriCorps members without using grant funds. Grantees may add the AmeriCorps logo to their own local program uniform items using federal funds. Please note that your program will be using the AmeriCorp s logo in the budget description. Include the amount of funds to purchase consumable supplies and materials, including member service gear and equipment that does not fit the definition above. You must individually list any single item costing $1,000 or mo re. Except for safety equipment, grantees may only charge the cost of member service gear to the federal share if it includes the AmeriCorps logo. All safety gear may be charged to the federal share, regardless of whether it includes the AmeriCorps logo. A ll other service gear must be purchased with non - CNCS funds. **F. Contractual and Consultant Services** Include costs for consultants related to the project’s operations, except training or evaluation consultants, who will be listed in Sections G. and H., b elow . **G. 1. Staff Training** Include the costs associated with training staff on project requirements and training to enhance the skills staff need for effective project implementation, i.e., project or financial management, team building, etc. If using a consultant(s) for training, i ndicate the estimated daily rate. **G. 2. Mem ber Training**  Include the costs associated with member training to support them in carrying out their service activities. You may also use this section to request funds to support training in Life after AmeriCor ps. If using a consultant(s) for training, indicate the estimated daily rate. **H. Evaluation** Include costs for project evaluation activities, including additional staff time or subcontracts, use of evaluation consultants, purchase of instrumentation, and other costs specifically for this activity not budgeted in Personnel Expenses. This cost does not include the daily/weekly gathering of data to assess progress toward meeting performance measures, but is a larger assessment of the impact your project is h aving on the community, as well as an assessment of the overall systems and project design. Indicate daily rates of consultants, where applicable. **I. Other Program Operating Costs**  Allowable costs in this budget category should include when applicable:  Cr iminal history background checks for all members and for all employees or other individuals who receive a salary, education award, living allowance, or stipend or similar payment from the grant (federal or non - federal share).  Office space rental for projec ts operating without an approved indirect cost rate agreement that covers office space. If space is budgeted and it is shared with other projects or activities, the costs must be equitably pro - rated and allocated between the activities or projects.  Utiliti es, telephone, i nternet and similar expenses that are specifically used for AmeriCorps members and AmeriCorps project staff, and are not part of the organization ’ s indirect cost allocation pool. If such expenses are budgeted and shared with other projects or activities, the costs must be equitably pro - rated and allocated between the activities or projects.  Recognition costs for members. List each item and provide a justification in the budget narrative. Gifts and/or food in an entertainment/event setting ar e not allowable costs.  Multi - state applicants: Indicate the number of subgrants and the average amount of subgrants. Indicate any match that you will require of your subgrants under the “grantee share” column in this category. Subgranted funds may only co ver costs allowable under federal and AmeriCorps regulations and provisions. **Section II. Mem ber Costs**  Mem ber Costs are identified as “Living Allowance” and “Member Support Costs.” Your required match can be federal, state, local, or private sector fund s.

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**A. Living Allowance**  The narrative should clearly identify the number of members you are supporting by category (i.e., full - time, halftime, reduced - half

- time, quarter - time, minimum - time) and the amount of living allowance they will receive, allocating appropriate portions between the CNCS share (CNCS Share) and grantee match (Grantee Share). The minimum and maximum living allowance amounts are provided in the Notice . In eGrants, enter the total number of members you are requesting in each category. Enter the average amount of the living allowance for each type of member. In addition, enter the number of members for which you are not requesting funds for a living allowance, but for which you are requesting education awards. **B. Member Support Costs** Consistent with the laws of the states where your members serve, you must provide members with the benefits described below .  **FICA.** Unless exempted by the IRS, all projects m ust pay FICA for any member receiving a living allowance, even when CNCS does not supply the living allowance. If exempted, please note in the narrative. In the first column next to FICA, indicate the number of members who will receive FICA. Calculate the FICA at 7.65% of the total amount of the living allowance.  **Worker’s Compensation.** Some states require worker’s compensation for AmeriCorps members. You must check with State Departments of Labor or State Commissions where members serve to determine if you are required to pay worker’s compensation and at what level. If you are not required to pay worker’s compensation, yo u must obtain Occupational, Accidental, Death and Dismemberment coverage for members to cover in service injury or accidents.  **Health Care.** You must offer or make available health care benefits to full - time members in accordance with AmeriCorps requirements. Except as stated below , you may not pay health care benefits to less - than - full - time members with CNCS funds. You may choose to provide health care benefits to less - than - full - time members from other sources (i.e., non - federal) but the cost cannot be included in the budget . Less - than - full - time members who are serving in a full - time capacity for a sustained period of time (such as a full - time summer project) are eligible for health care benefits. In your budget narrative, indicate the number of members who will receive health care benefits. CNCS will not pay for dependent coverage.  **Unemployment Insurance and Other Member Support C osts.**  Include any other required member support costs here. Some states require unemployment coverage for their AmeriCorps members. You may not charge the cost of unemployment insurance taxes to the grant unless mandated by state law. Programs are responsi ble for determining the requirements of state law by consulting State Commissions, legal counsel, or the applicable state agencies. **Section III. Administrative/Indirect Costs Definitions**  Administrative costs are general or centralized expenses of the o verall administration of an organization that receives CNCS funds and do not include particular project costs. These costs may include administrative staff positions. For organizations that have an established indirect cost rate for federal awards, adminis trative costs mean those costs that are included in the organization’s indirect cost rate agreement. Such costs are generally identified with the organization’s overall operation and are further described in Office of Management and Budget Circulars A - 21, A - 87, and A - 122. **Options for Calculating Administrative/Indirect Costs (choose either A OR B)**  Applicants choose one of two methods to calculate allowable administrative costs

– a CNCS - fixed percentage rate method or a federally approved indirect cost rate method. Regardless of the option chosen, the CNCS share of administrative costs is limited to 5% of the total CNCS funds **actually expended** under this grant. Do not create additional lines in this category.

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**A. CNCS**  **- Fixed Percentage Method**  **Five Percent Fixed Administrative Costs Option**  The CNCS - fixed percentage rate method allow s you to charge administrative costs up to a cap without a federally approved indirect cost rate and without documentation supporting the allocation. If you choose the CNCS - fixed percentage rate method (Section IIIA in eGrants), you may charge, for administrative costs, a fixed 5% of the total of the CNCS funds expended. In order to charge this fixed 5%, the grantee match for administrative costs may not exceed 10% of all direct co st expenditures. 1. To determine the ma ximum CNCS share for Section III: Multiply the sum of the CNCS funding shares of Sections I and II by 0.0526. This is the maximum amount you can request as Corporation share. The factor 0.0526 is used to calculate the 5 % maximum amount of federal funds that may be budgeted for administrative (indirect) costs, rather than 0.0500, as a way to mathematically compensate for determining Section III costs when the total budget (Sections I + II + III) is not yet established. Enter this amount as the CNCS share for Section III A. 2. To determine the Grantee share for Section III: Multiply the total (both Corporation and grantee share) of Sections I and II by 10% (0.10) and enter this amount as the grantee share for Section III A. 3. Enter the sum of the CNCS and grantee shares un der Total Amount. If a commission elects to retain a share of the 5% of federal funds available to programs for administrative costs, that decision is identified within each subgrant’s budget. To calculate these fractional shares, within Section III of th e subgrant budget, **one -**  **fifth (20%) of the federal dollars budgeted for adm inistrative costs is allocated to the**  **commission’s share and four -**  **fifths (80%) of the federal dollars budgeted for adm inistrative costs are**  **allocated to the program ’s share. The allo**  **cation between commission and program shares would be**  **calculated as follows: ([Section I] + [Section II] x 0.0526) x (0.20) = Commission Share**  **([Section I] + [Section II] x 0.0526) x (0.80) = Subgrantee Share** If a commission elects to retain a share that is less than 1% budgeted for administrative costs, adjust the calculation above, as appropriate. **B. Federally Approved Indirect Cost Rate**  If you have a federally approved indirect cost rate and choose to use it, the rate will constitute documentation of yo ur administrative costs, including the 5% maximum payable by CNCS . Specify the Cost Type for which your organization has current documentation on file, i.e., Provisional, Predetermined, Fixed, or Final indirect cost rate. Supply your approved IDC rate (percentage) and the base upon which this rate is calculated (direct salaries, salaries and fringe benefits, etc.). It is at your discretion whether or not to claim your entire IDC rate to calculate administrative costs. If you choose to claim a lower rat e, please include this rate in the Rate Claimed field. 1. Determine the base amount of direct costs to which you will apply the IDC rate, including both the CNCS and Grantee shares, as prescribed by your established rate agreement (i.e., based on salarie s and benefits, total direct costs, or other). Then multiply the appropriate direct costs by the rate being claimed. This will determine the total amount of indirect costs allowable under the grant. 2. To determine the CNCS share: Multiply the sum of th e CNCS funding share in Sections I and II by 0.0526. This is the maximum amount you can claim as the CNCS share of indirect costs. If a commission elects to retain a share of the 5% of federal funds available, please note the percentage or amount in the te xt. There is no separate line item to show this calculation.

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3. To determine the Grantee share: Subtract the amount calculated in step b ( the CNCS administrative share) from the amount calculated in step a (the Indirect Cost total). This is the amount the applicant can claim as grantee share for administrative costs. **Source of Match** In the “Source of Match” field that appears at the end of Budget Section III , enter a description of the Source of Match, the amount, the match classification (Cash, In - kind, o r Not Available) and Match Source (State/Local, Federal, Private, Other or Not Available) **for your entire match.** Define any acronyms the first time they are used. Enter each source match separately.

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## AT **TA CHMENT**  **E : Budget Worksheet (eGrants Budget**  **Section) Section I. Program Operating Costs**  **A. Personnel Expenses**  Position/Title/Description Qty Annual Salary % Time **Total Amount CNCS Share**  **Grantee Share**
Totals 

### B. **Personnel Fringe Benefits** Purpose/Description Calculation **Total Amount CNCS Share**  **Grantee Share**
Totals 

### C.1. **Staff Travel** Purpose Calculation **Total Amount CNCS Share**  **Grantee Share**

Totals 

### C. 2. **Member Travel** Purpose Calculation **Total Amount CNCS Share**  **Grantee Share**

Totals 

### D. **Equipment** Item/ Purpose/Justification Qty Unit Cost **Total Amount CNCS Share**  **Grantee Share**

Totals 

### E. **Supplies** Purpose Calculation **Total Amount CNCS Share**  **Grantee Share**

Totals

### 33

**F. Contractual and Consultant Services**  Purpose Calculation Daily Rate **Total Amount CNCS Share**  **Grantee Share**
Totals 

### G.1. **Staff Training** Purpose Calculation Daily Rate **Total Amount CNCS Share**  **Grantee Share**
Totals 

### G.2. **Member Training** Purpose Calculation Daily Rate **Total Amount CNCS Share**  **Grantee Share**
Totals 

### H. **Evaluation** Purpose Calculation Daily Rate **Total Amount CNCS Share**  **Grantee Share**
Totals 

### I. **Other Program Operating Costs** Purpose Calculation Daily Rate **Total Amount CNCS**  **Share Grantee Share** 
Totals


### Subtotal Section I: **Total Amount CNCS Share**  **Grantee Share**

### 34

**Section II. Member Costs A.**  **Living Allowance** Item # Mbrs Allowance

Rate # w/o

Allowanc e **Total Amount CNCS Share**  **Grantee Share** Full Time (1700 hrs) Half Time (900 hrs) 1st Year of 2 - Year Half Time 2 nd Year of 2 - Year Half Time Reduced Half Time (675 hrs) Quarter Time (450 hrs) Minimum Time (300 hrs) Totals 

### B. **Member Support Costs**  Purpose Calculation Daily Rate **Total Amount CNCS Share**  **Grantee Share**
Totals


### Subtotal Section II: **Total Amount CNCS Share**  **Grantee Share** 

### Subtotal Sections I + II:

### 35

**Section III. Administrative/Indirect Costs A.**  

### CNCS **- fixed Percentage**  **Rate** Purpose Calculation **Total Amount CNCS Share**  **Grantee Share**

Totals **B. Federally**  **A pproved Indirect Cost Rate**  Cost Type Cost

Basis Calculation Rate Rate Claimed **Total Amount CNCS Share**  **Grantee Share**

**Total Sections I + II + III: Total Amount**  **CNCS Share Grantee Share** 

**Budget Total: Validate this budget Required Match Percentages:**  **Total Amount CNCS Share**  **Grantee Share**

**Source of Match Source(s), Type,**  **Am ount, Intended Purpose**  **Private State and/or Local**  **Federal Sources**  **In -**  **ki nd**  $ $ $ . **Cash** $ $ $ **Total** $ $ $

### 36

**AT TA**  **CHMENT F**  **: Detailed Budget Instructions for Fixed -**  **amount Grants (eGrants Budget Section)**  **These instructions apply only to applicants for fixed**  **- amount grants, including education award programs**  **(EAPs).** EAP and Fixed - amount Grant applicants may only request a fixed amount of funding per MSY. Therefore, Fixed amount applicants are not required to complete a detailed budget. In addition, the matching requirements in 45 CFR §§ 2521.40

– 2521.95 do not apply to EAP and other Fixed - amount grant applicants. If you are applying for a Stipended Fixed - amount grant, you must pay at least the minimum living allowance list ed in the N otice for each ty pe of position you are proposing. Both professional corps and stipended fixed - amount grants can only apply for full - time members or less - than - full - time members serving in a full - time capacity. You must describe how your less than - full - time mem

bers will serve in a full - time capacity in your program narrative. **Budget Section II. AmeriCorps Mem ber Positions**  **Mem ber Positions**  Identify the number of members you are requesting by category (i.e. full - time, half - time, reduced half

- time, quarter time, minimum - time) and list under the column labeled **#w/o Allow** (without CNCS - funded living allowance.) **Leave all other colum ns blank**  . T he total number of member service years (MSY) will **automatically calculate** at the bottom of the Member Positions chart. The MSY are calculated as follows:

Under “Calculation,” you will enter the calculation for your grant request. Applicants may request up to $800 per member service year (MSY). **Mem ber Positions**  **Calculation MSY**  _____Full - time (1700 hours) (______ members x 1.000) = _____1 - Year Half

- time (900 hours) (______ members x 0.500) =

_____Reduced half

- time (675 hours) (______ members x 0.3809524) = _____Quarter - time (450 hours) (______ members x 0.26455027) = _____Minimum - time (300 hours) (______ members x 0.21164022) = **Total MSY**

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Display your calculation in the following format:

Ty pe the total amount requested in the “Total Amount” & “CNCS Share” columns. Leave the “Grantee Share” blank. See example below (applies to a Stipended Fixed Amount grant) : **Purpose Calculation**  **Total Am**  **ount CNCS** 

**Share Grantee** 

**Share edit**  **del Program Grant**  **Request** 47.5 MSY X $ 9,500 /MSY $ 451,250 $ 451,250 $0 view **Subtotal** $ 451,250 $ 451,250 $0 Total # of MSYs ________ x MSY amount (up to $800 for EAP, $2,000 for Professional Corps and $13,000 f or Stipended Fixed Amount)_______ = Total Grant Request **$____**

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## AT **TA CHMENT**  **G : Budget Worksheet for Fixed**  **- Am**  **ount Grants (eGrants Budget Section)**  Complete the fields for the # w/o Allowance only.

**Member Positions**

**Source of Funds** Fixed amount grantees must have additional revenue to operate the program. Describe your srouces of revenue and the amounts you expect from each one. **Item #**  **Mbrs Al**  **lowance**

**Rate # w/o** 

**Al low**  **Total**

**Am ount**  **CNCS**

**Share Grantee** 

**Share** Full Time (1700 hrs) 1 - Year Half Time (900 hrs) 2 - Year Half Time (1 st Year) 2 - Year Half Time (2 nd Year) Reduced Half Time (675 hrs) Quarter Time (450 hrs) Minimum Time (300 hrs) **Subtotal MSY**  **Cost/MSY**

**Purpose Calculation**  **Total Am**  **ount CNCS Share**  **Grantee Share**  **Program Grant Request**  **Subtotal**

### 39



## AT **TA CHMENT**  **H : Budget Checklist**  Below is a checklist to help you make certain that you submit an accurate budget narrative that meets AmeriCorps requirements. Note: This does not apply to Fixed - amount Grants. **In Compliance? Section I. Program** **Operating Costs** Yes __ No __ Costs charg ed under the Personnel line item directly relate to the operation of the AmeriCorps

project? Examples include costs for staff that recruit, train, place, or supervise members as well as manage the project. Yes __ No __ Staff indirectly involved in the management or operation of the applicant organization is funded

through the administrative cost section (Section III.) of the budget? Examples of administrative costs include central management and support functions. Yes __ No __ Staff fundraising expens es are not charged to the grant? You may not charge AmeriCorps staff

members’ time and related expenses for fundraising to the federal or grantee share of the grant. Expenses incurred to raise funds must be paid out of the funds raised. Development officer s and fundraising staff are not allowable expenses. Yes __ No __ All positions in the budget are fully described in the narrative? Yes __ No __ The types of fringe benefits to be covered and the costs of benefit(s) for each staff position are

described ? Allowable fringe benefits typically include FICA, Worker’s Compensation, Retirement, SUTA, Health and Life Insurance, IRA, and 401K. You may provide a calculation for total benefits as a percentage of the salaries to which they apply or list each benefit as a separate item. If the fringe amount is over 30%, please list separately. Yes __ No __ Holidays, leave, and other similar vacation benefits are not included in the fringe benefit rates but

are absorbed into the personnel expenses (salary) budget li ne item? Yes __ No __ The purpose for all staff and member travel is clearly identified? Yes __ No __ You have budgeted funds for State Commission and National Direct staff travel to CNCS sponsored

meetings in the budget narrative under Staff Travel? Yes __ No __ Funds to pay relocation expenses of AmeriCorps members are not in the federal share of the

budget? Yes __ No __ Funds for the purchase of equipment (does not include general use office equipment) are limited to

10% of the total grant amount? Yes __ No __ All single equipment items over $5000 per unit are specifically listed? Yes __ No __ Justification/explanation of equipment items is included in the budget narrative? Yes __ No __ All single supply items over $1000 per unit are specifically listed? Yes __ No __ Cost of items with the AmeriCorps logo that will be worn daily is included for all AmeriCorps

members? Or if not, there is an explanation of how the pr ogram will be providing the AmeriCorps logo item to AmeriCorps membe rs using funds other than CNCS grant funds . Yes __ No __ You only charged to the federal share of the budget member service gear that includes the

AmeriCorps logo and noted that the gear will have the AmeriCorps logo , with the exception of safety equipme nt? Yes __ No __ Does the budget reflect adequate budgeted costs for project evaluation? Yes __ No __ Have you provided budgeted costs for criminal history checks of members and grant - funded staff

that are in covered positions per 45 CFR 2522.205? Yes __ No __ Are all items in the budget narrative itemized and the purpose of the funds justified?

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**In Compliance? Section II. Mem** **ber Costs** Yes __ No __ Are the living allowance amounts correct? Full - time AmeriCorps members must receive at least the

minimum living allowance. Note: Programs in existence prior to September 21, 1993 may offer a low er living allowance than the minimum. If such a program chooses to offer a living allowance, it is exempt from the minimum requirement, but not from the m aximum requirement . Yes __ No __ Living allowances are not paid on an hourly basis? They may be calculated using service hours and

program length to derive a weekly or biweekly distribution amount. Divide the distribution in equal increments that are no t based on the specified number of hours served. Yes __ No __ Is FICA calculated correctly? You must pay FICA for any member receiving a living allowance.

Unless exempted by the IRS, calculate FICA at 7.65% of the total amount of the living allowance. Yes __ No __ Is the Worker’s Compensation calculation correct? Some states require worker’s compensation for

AmeriCorps members. Check with your local State Department of Labor or State Commission to determine whether or not you are required to pay worker ’s compensation and at what level (i.e., rate). If you are not required to pay worker’s compensation, you need to provide similar coverage for members’ on - the -

job injuries through their own existing coverage or a new policy purchased in accordance with norma l procedures (i.e., Death and Dismemberment coverage). Yes __ No __ Health care is provided for full - time AmeriCorps members only (unless part - time serving in a full time capacity)? If your project chooses to provide health care to other half - time memb ers, you may not use federal funds to help pay for any portion of the cost. Projects must provide health care coverage to all full - time members who do not have adequate health care coverage at the time of enrollment or who lose coverage due to participatio n in the project. In addition, projects must provide coverage if a full - time mem ber loses coverage during the term of service through no deliberate act of his/her own. Yes __ No __ Unemployment insurance is only budgeted if state law requires it? **In Compliance?**  **Section III. Administrative/Indirect Costs** Yes __ No __ Applicant has chosen Option A

– CNCS - fixed percentage method and the maximum federal share

of administrative costs does not exceed 5% of the total federal funds budgeted? To determine th e federal administrative share, multiply all other budgeted federal funds by .0526. Yes __ No __ Applicant has chosen Option A

– CNCS fixed percentage method and the maximum grantee share

is at 10% or less of total budgeted funds? Yes __ No __ Applicant has chosen Option B

– federally approved indirect cost rate method and documentation

submitted to CNCS if applying directly to CNCS ? Administrative costs budgeted include the following: (1) indirect costs such as legal staff, central management and support functions; (2) costs for financial, accounting, audit, internal evaluations, and contracting functions; (3) costs for insurance that protects the entity that operates the project; and (4) the portion of the salaries and benefits of the director and any other project administrative staff not attributable to the time spent in direct support of a specific project. Yes __ No __ Applicant has chosen Option B

– The maximum grantee share does not exceed the federally

approved rate, less the 5% CNCS sh are? Yes __ No __ Applicant has chosen Option B - the type of rate, the IDC rate percentage, the rate claimed and the

base to w hich the rate is applied has been specified? **In Compliance? Match**  Yes __ No __ Is the overall match being met at the required level, based on the year of funding? Yes __ No __ For all matching funds, the source(s) [private, state and local, and federal], the type of contribution

(cash or in - kind), and the amount (or an estimate) of match, are clearly identified in the narrative and in the Source of Match field in eGrants?

### 41

**AT TA**  **CHMENT I**  **: A lternative Match Instructions**  Grantees are required to meet an overall matching rate that increases over time. You have the flexibility to meet the overall match requirements in any of the three budget areas, as long as the minimum match of 24% for the first three years, and the increasing minimums in years thereafter, are maintained. See 45 CFR §§ 2521.35

–2521.90 for the specific regulations. **Special Circumstances for an Alterna tive Match Schedule:**  Under certain circumstances, applicants may qualify to meet alternative matching requirements that increase over the years to 35% instead of 50% as specified in the regulations at §2521.60(b). To qualify, you must demonstrate that you r program is either located in a rural county or in a severely economically distressed community as defined below . **A. Rural County:** In determining whether a program is rural, CNCS will consider the most recent Beale code rating published by the U.S. Department of Agriculture for the county in which the program is located. Any program located in a county with a Beale code of 6, 7, 8 or 9 is eligible to apply for the alternative matc h requirement. See Attachment J for the Table of Beale codes. **B. Severely Econom** **ically Distressed County:** In determining whether a program is located in a severely economically distressed county, CNCS will consider the following list of county - level char acteristics. See Attachment J for a list of website addresses where this publicly available information can be found.  The county - level per capita income is less than or equal to 75 percent of the national average for all counties using the most recent cens us data or Bureau of Economic Analysis data;  The county - level poverty rate is equal to or greater than 125 percent of the national average for all counties using the most recent census data; and  The county - level unemployment is above the national average f or all counties for the previous 12 months using the most recently available Bureau of Labor Statistics data.  The areas served by the program lack basic infrastructure such as water or electricity. **C. Program Location**  : Except when approved otherwise, CN CS will determine the location of your program based on the legal applicant’s address. If you believe that the legal applicant’s address is not the appropriate way to consider the location of your program, you must provide relevant facts about your program location in your request. CNCS will, in its sole discretion, determine whether some other address is more appropriate for determining a program’s location. If your program is located in one of these areas, see the instructions below for applying for this alternative match schedule. You must submit your request to the alternative schedule at least 60 days before the AmeriCorps application is due. CNCS will review your request and notify you within 30 days if you qualify for the alternative schedule and pro vide instructions for entering your budget into eGrants under the Alternative Match Schedule. If approved for the alternative schedules, programs will base their budget in the upcoming application on the approved alternative match. The alternative match r equirement will be in effect for whatever portion of the three year project period remains or if applying as a new grantee, for the upcoming three - year grant cycle. **D. Instructions for the Alternative Match Schedule:** Program s operating in one state must s end their requests to the State Commission for review and approval. The Commission will then forward the approved request to CNCS for consideration. **Submit e -**  **mail applications per the**  **Notice instructions.**  **to:**

### 42

**AT TA**  **CHMENT J**  **: Beale Codes and County**  **- Level Economic Data**  **Rural Community Beale codes**  are published by the U.S. Department of Agriculture and are used to classify counties as being more urban or more rural. Counties are designated on a scale from one to nine according to the following descriptions: **2003 Beale Codes Code#**  **Me tropolitan** 

**Type Description**  1 Metropolitan Counties in metro areas of 1 million population or more 2 Metropolitan Counties in metro areas of 250,000 to 1 million 3 Metropolitan Counties in metro areas of fewer than 250,000 4 Non - metro Urban population of 20,000 or more, adjacent to a metropolitan area 5 Non - metro Urban population of 20,000 or more, not adjacent to a metropolitan area 6 Non - metro Urban population of 2,500 to 19,999, adjacent to a metropolitan area 7 Non - metro Urban population of 2,500 to 19,999, not adjacent to a metropolitan area 8 Non - metro Com pletely rural or less than 2,500 urban population, adjacent to a metropolitan area 9 Non - metro Com pletely rural or less than 2,500 urban population, not adjacent to a metropolitan area Any program located in a county with a Beale code of 6, 7, 8, or 9 is eligible to apply for the alternative match. **Severely Econom ically Distressed Community**  The following table provides the website addr esses where the publicly available information on county - level economic data including per capita income, poverty rate, and unemployment levels can be found.

**WEBSITE ADDRESS EXPLANATION**  www.econdata.net **Econdata.Net** : This site Links to a variety of social and economic data by states, counties and metro areas. http://www.bea.gov/regional/ **Bureau of Econom ic Analysis’ Regional**  **Economic Information System (REIS):**  Provides data on per capita income by county for all states except Puerto Rico. www.census.gov/hhes/www/saipe/index.html **Census Bureau’s Small Area Poverty Estimates**  : Provides data on poverty and population estimates by county for all states except Puerto Rico. www.census.gov/main/www/cen2000.html **Census Bureau’s American Fact -**  **finder** : Provides all 1990 and 2000 census data including estimates on poverty, per capita income and unemployment by counties, states, and metro areas including Puerto Rico.

### 43 **WEBSITE ADDRESS EXPLANATION**  www.bls.gov/lau/home.htm **Bureau of Labor Statistics’ Local Area Unemployment**  **Statistics (LAUS):** Provides data on annual and monthly employment and unemployment by counties for all states including Puerto Rico. http://www.ers.usda.gov/Data/RuralUrbanContinuumC odes/ **US Department of Agriculture’s Rural**   ** Urban Continuum Codes (Beale codes):** Provides urban rural code for all counties in US. www.cen sus.gov/hhes/www/saipe/index.html **Census Bureau’s Small Area Poverty Estimates: Provides data on poverty and**  **population estimates by county for all states except Puerto Rico.**  www.census.gov/main/www/cen2000.html **Census Bureau’s American Fact -**  **finder: Provides all 1990 and 2000 census data**  **including estimates on poverty, per capita income and une**  **mployment by counties, states, and m**  **etro areas including Puerto Rico.**  

### www.bls.gov/lau/home.htm **Bureau of Labor Statistics’ Local Area Unemployment Statistics (LAUS):**  **Provides data on annual and monthly employment and unemployment by**  **counties for all states including Puerto Rico**  **.** http://www.ers.usda.gov/Data/RuralUrbanContinu umCodes/ **US Department of Agriculture’s Rural**   ** Urban Continuum Codes (Beale codes):** **Provides urban rural code for all counties in U**  **S.**

### 44

**AT TA**  **CHMENT K**  **: A ssurances and Certifications**  **(eGrants Review, A uthorize and Submit Section)**  **Instructions By signing and submitting this application, as the duly authorized representative of the applicant, you certify that the**  **applicant will comply with the Assurances and Certifications described below. a)**  **Inability to certify** Your inability to provide the a ssurances and certifications listed below will not necessarily result in denial of a grant. You must submit an explanation of why you cannot do so. We will consider your explanation in determining whether to enter into this transaction. However, your failure to furnish an explanation will disqualify your application. **b) Erroneous certification or assurance**  The assurances and certifications are material representations of fact upon which we rely in determining whether to enter into this transaction. If we l ater determine that you knowingly submitted an erroneous certification or assurance, in addition to other remedies available to the federal government, we may terminate this transaction for cause or default. **c) Notice of error in certification or assuranc**  **e** You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous when submitted or has become erroneous because of changed circumstances. **d) Definitions**  The terms “covered transaction”, “debarred”, “suspended”, “ineligible”, “lower tier covered transaction”, “participant”, “person”, “primary covered transaction”, “principal”, “proposal”, and “voluntarily excluded” as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. An applicant shall be considered a “prospective primary participant in a covered transaction” as defined in the rules implementing Executive Order 12549. You may contact us for assistance in obtaining a copy of those regulations. **e) Assurance requirement for subgrant agreements**  You agree by submitting this proposal that if we approve your application you shall not knowingly enter into any lower tier covered transaction with a person who is debarred, sus pended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by us. **f) Assurance inclusion in subgrant agreements**  You agree by submitting this proposal that you will obtain an assurance from prospective participants in all lower tier covered transactions and in all solicitations for lower tier covered transactions that the participants are not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction. **g) Assurance**  **of subgrant principals** You may rely upon an assurance of a prospective participant in a lower - tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless you know that the assurance is erroneous. You may decide the method and frequency by which you determine the eligibility of your principals. You may, but are not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs. **h) Non**  **- assurance in su**  **bgrant agreements** If you knowingly enter into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, we may terminate this transaction for cause or default. **i) Prudent person standard**  Nothing contained in the aforementioned may be construed to require establishment of a system of records in order to render in good faith the assurances and certif ications required. Your knowledge and information is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

### 45

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

 Has the legal authority to apply for federal assistance, and the institutional, managerial, and financial capability (including funds sufficient to pay the non - federal share of project costs) t o ensure proper planning, management, and completion of the project described in this application.
 Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.  Will establish safeguards to prohibit emp loyees from using their position for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.  Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.  Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728 - 4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of O PM’s Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).
 Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: Title VI of the Civil Rights Act of 1964 (P.L. 88 - 352) which prohibits discrimination on the basis of race, color, or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681 - 1683, and 1685 - 1686). which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilita tion Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of disability (d) The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101 - 6107), which prohibits discrimination on the basis of age; (e) The Drug Abuse Office and Treatment Act of 1972 (P.L. 92 - 255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 - 616), as amended, relating to no ndiscrimination on the basis of alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290dd - 3 and 290ee - 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VII I of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the National and Community Service Act of 1990, as amended; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.  Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91 - 646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for proj ect purposes regardless of federal participation in purchases.  Will comply with the provisions of the Hatch Act (5 U.S.C. 1501 - 1508 and 7324 - 7328) which limit the political activities of employees whose principal employment activities are funded in whole o r in part with Federal funds.  Will comply, as applicable, with the provisions of the Davis - Bacon Act (40 U.S.C 276a and 276a - 77), the Copeland Act (40 U.S.C 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 - 333), regarding labor standards for Federally assisted construction sub - agreements.  Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93 - 234) which requires the recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.
 Will comply with environmental standards which may be prescribed pursuant to the fo llowing: (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 p ursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved state management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C 1451 et seq.) ; (f) conformity of federal actions to State (Clean Air) Implementation Plans under

### 46 Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93 - 523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93 - 205).
 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C 1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.
 Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and prot ection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16U.S.C. 469a - l et seq.).
 Will comply with P.L. 93 - 348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.
 Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 - 544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance.
 Will comply with the Lead - Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801 et seq.) which prohibits the use of lead based paint in construction or rehabilitation of residence structures.
 Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984, as amended, and OMB Circular A - 133, Audits of States, Local Governments, and Non - Profit Organizations.  Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, application guidelines, and policies governing this program.

 Will comply with all rules regarding prohibited activities, including those stated in applicable Notice, grant provisions, and program regul ations, and will ensure that no assistance made available by the Corporation will be used to support any such prohibited activities.

 Will comply with the nondiscrimination provisions in the national service laws, which provide that an individual with res ponsibility for the operation of a project or program that receives assistance under the national service laws shall not discriminate against a participant in, or member of the staff of, such project or program on the basis of race, color, national origin, sex, age, political affiliation, disability, or on the basis of religion. (NOTE: the prohibition on religious discrimination does not apply to the employment of any staff member paid with non - Corporation funds or paid with Corporation funds but employed with the organization operating the project prior to or on the date the grant was awarded. If your organization is a faith - based organization that makes hiring decisions on the basis of religious belief, your organization may be entitled, under the Religiou s Freedom Restoration Act, 42 U.S.C. § 2000bb, to receive federal funds and yet maintain that hiring practice, even though the national service legislation includes a restriction on religious discrimination in employment of staff hired to work on a Corporation - funded project and paid with Corporation grant funds. (42 U.S.C. §§ 5057(c) and 12635(c)). For the circumstances under which this may occur, please see the document “Effect of the Religious Freedom Restoration Act on Faith - Based Applicants for Grants” on the Corporation’s website at: http://www.usdoj.gov/archive/fbci/effect - rfra.pdf .  Will comply with all other federal statutes relating to nondiscrimination, including any self - evaluation requirements. 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 Alcoh ol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 - 616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 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 o f housing; and (i) the requirements of any other nondiscrimination statute(s) which may apply to the application.

 Will provide, in the design, recruitment, and operation of any AmeriCorps program, for broad - based input from

– (1) the community served, the municipality and government of the county (if appropriate) in which the community is located, and potential partic ipants in the program; and (2) community- based agencies with a demonstrated record of

### 47 experience in providing services and local labor organizations representing employees of service sponsors, if these entities exist in the area to be served by the program ;
 Will, prior to the placement of participants, consult with the appropriate local labor organization, if any, representing em ployees in the area who are engaged in the same or similar work as that proposed to be carried out by an AmeriCorps program, to ensure compliance with the nondisplacement requirements specified in section 177 of the NCSA;

 Will, in the case of an AmeriCorps program that includes or serves children, consult with the parents or legal guardians of children in developing and operating the program;

 Will, before transporting minor children, provide the children’s parents or legal guardians with the reason for the transportation and obtain the parent’s or legal guardian’s permission for such transportation, consistent with state law;

 Will, in the case of an AmeriCorps program that is not funded through a State, consult with and coordinate activities with the State Commission for the state in which the program operates.

 Will ensure that any national service program carried out by the applicant using assistance provided under section 121 of the National and Community Service Act of 1990 and any national service program supported by a grant made by the applicant using such assistance will address unmet human, educational, environmental, or public safety needs through services that provide a direct benefit to the community in which the service is performed;

 Will comply with the nonduplication and nondisplacement requirements set out in section 177 of the National and Community Service Act of 1990, and in the Corporation’s regulations at § 2540.100;

 Will comply with the grievance procedure requirements as set out in section 176(f) of the National and Community Service Act of 1990 and in the Corporation’s regulations at 45 CFR § 2540.230;

 Will provide participants in the national service program with the training, skills, and knowledge necessary for the projects that participants are called upon to perform, including training on prohibited activities;

 Will provide support services to parti cipants, such as information regarding G.E.D. attainment and post - service em ployment, and, if appropriate, opportunities for participants to reflect on their service experiences;

 Will arrange for an independent evaluation of any national service program carried out using assistance provided to the applicant under section 121 of the National and Community Service Act of 1990 or, with the approval of the Corporation, conduct an internal evaluation of the program;

 Will apply measurable performance goals an d evaluation methods, which are to be used as part of such evaluation to determine the program’s impact on communities and persons served by the program, on participants who take part in the projects, and in other such areas as required by the Corporation;

 Will ensure the provision of a living allowance and other benefits to participants as required by the Corporation;

 Has not violated a Federal criminal statute;

 If a state applicant, will ensure that the State subgrants will be used to support national service programs selected by the State on a competitive basis;

 If a state applicant, will seek to ensure an equitable allocation within the State of assistance and approved national service positions, taking into consideration such factors as the locations of the programs, population density, and economic distress;

 If a state applicant, will ensure that not less than 60% of the assistance will be used to make grants to support national service programs other than those carried out by a State agen cy , unless the Corporation approves otherwise.

### 48 **CERTIFICATIONS Certification** 
**– Debarment, Suspension, and Other Responsibility Matters**  This certification is required by the government - wide regulations implementing Executive Order 12549, Debarment and Suspension, 2 CFR Part 180, Section 180.335, What information must I provide before entering into a covered transaction with a Federal agenc

y? As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that neither the applicant nor its principals:
 Is presently excluded or disqualified;  Has been convicted within the preceding three years of any of the offenses listed in § 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period;  Is presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or loca l) with commission or any of the offenses listed in § 180.800(a); or  Has had one or more public transactions (Federal, State, or local) terminated within the preceding three years for cause or default. **Certification**
**– Drug Free Workplace**  This certification is required by the Corporation’s regulations implementing sections 5150 - 5160 of the Drug - Free Workplace Act of 1988 (P.L. 100 - 690), 45 CFR Part 2545, Subpart B. The regulations require certification by grantees, prior to award, that they will make a good faith effort, on a continuing basis, to maintain a drug - free workplace. The certification set out below is a material representation of fact upon which reliance will be placed when the agency determines to award the grant. False certification or violation of the certification may be grounds for suspension of payments, suspension or termination of grants, or government - wide suspension or debarment (see 45 CFR Part 2542, Subparts G and H). As the duly authorized representative of the grante e, I certify, to the best of my knowledge and belief, that the grantee will provide a drug - free workplace by: A. Publishing a drug - free workplace statement that:

a. Notifies employees that the unlawful manufacture, distribution, dispensing, possession, or use o f a controlled substance is prohibited in the grantee’s workplace; b. Specifies the actions that the grantee will take against employees for violating that prohibition; and c. Informs employees that, as a condition of employment under any award, each employee will abide by the terms of the statement and notify the grantee in writing if the employee is convicted for a violation of a criminal drug statute occurring in the workplace within five days of the conviction; B. Requiring that a copy of the statement describ ed in paragraph (A) be given to each employee who will be engaged in the performance of any Federal award; C. Establishing a drug - free awareness program to inform employees about: a. The dangers of drug abuse in the workplace; b. The grantee’s policy of maintaini ng a drug - free workplace; c. An y available drug counseling, rehabilitation, and employee assistance programs; and d. The penalties that the grantee may impose upon them for drug abuse violations occurring in the workplace; D. Providing us, as well as any other Fed eral agency on whose award the convicted employee was working, with written notification within 10 calendar days of learning that an employee has been convicted of a drug violation in the workplace; E. Taking one of the following actions within 30 calendar d ays of learning that an employee has been convicted of a drug violation in the workplace: a. Taking appropriate personnel action against the employee, up to and including termination; or b. Requiring that the employee participate satisfactorily in a drug abuse assistance or rehabilitation program approved for these purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

### 49 F. Making a good faith effort to continue to maintain a drug - free workplace through implementation of paragra phs (A) through (E). **Certification -**  **Lobbying Activities** As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that:

 No federal appropriated funds have been paid or will be paid, by or on behalf of the applicant, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer of Congress in connection with the awarding of any federal contract, the making of any federal loan, the entering into of any cooperative agreement, or modification of any federal contract, grant, loan, or cooperative agreement;  If any funds other than federal appropriated funds have been paid or will be paid t o any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the applicant will submit Standard Form- LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions;  The applicant will require that the language of this certification be included in the award documents for all subcontra cts at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients will certify and disclose accordingly. **Erroneous certification or assurance** The assurances and certifications ar e material representations of fact upon which we rely in determining whether to enter into this transaction. If we later determine that you knowingly submitted an erroneous certification or assurance, in addition to other remedies available to the federal government, we may terminate this transaction for cause or default. **Notice of error in certification or assurance** You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous when submitted or ha s become erroneous because of changed circumstances. **Definitions** The terms “debarment”, “suspension”, “excluded”, “disqualified”, “ineligible”, “participant”, “person”, “principal”, “proposal”, and “voluntarily excluded” as used in this document have the me anings set out in 2 CFR Part 180, subpart I, “Definitions.” A transaction shall be considered a “covered transaction” if it meets the definition in 2 CFR part 180 subpart B, “Covered Transactions.” **Assurance requirement for subgrant agreements** You agre e by submitting this proposal that if we approve your application you shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covere d transaction, unless authorized by us. **Assurance inclusion in subgrant agreements** You agree by submitting this proposal that you will obtain an assurance from prospective participants in all lower tier cover ed transactions and in all solicitations for lo wer tier covered transactions that the participants are not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction. **Assurance of subgrant principals** You may rely upon an assurance of a prospective participant in a lower - tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless you know that the assurance is erroneous. You may decide the method and frequency by which you determine the eligibility of your principals. You may, but are not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs. **Non -**  **assurance in subgrant agreements** If you knowingly enter into a lower tier covered transaction with a person who is s uspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, we may terminate this transaction for cause or default. **Prudent person standard** Nothing contained in the aforementioned may be construed to require establishment of a system of records in order to render in good faith the assurances and certifications required. Your knowledge and information is not required to exceed that which is normally po ssessed by a prudent person in the ordinary course of business dealings.

### 50

**Certification -**  **Grant Review Process (State Commissions Only)** I certify that in conducting our review process, we have ensured compliance with the National and Community Service Act of 1990, the Corporation's peer review requirements, and all state laws and conflict of interest rules. 

## ASSURANCES AND CERTI **FICATIONS ASSURANCE SIGNATURE**  **: NOTE: Sign this form and include in the application.**  **SIGNATURE:** By signing this assurances page, you certify that you agree to perform all actions and support all intentions in the Assurances section. **Organization Name** 

### : **Program Name** 

### : **Name and Title of Authorized Representative** 

### : **Signature** 

### : **Date** 

### : **CERTIFICATION SIGNAT URE**  **: NOTE: Sign this form and include in the application.**  

### SIGNATURE: By signing this certification page, you certify that you agree to perform all actions and support all intentions in the Certification sections of this application. The three Certifica tions are: Certification: Debarment, Suspension and Other Responsibility Matters Certification: Drug - Free Workplace Certification: Lobbying Activities **Organization Name** 

### : **Program Name** 

### : **Name and Title of Authorized Representative** 

### : **Signature** 

### : **Date** 

### :

### 51



## ATTACHMENT **L :**  **Beneficiary Populations**  **/Grant Characteristics**

 AmeriCorps member Population

– Communities of Color  AmeriCorps member Population

– Lo w - income individuals  AmeriCorps member Population

– Native Americans  AmeriCorps member Population

– New Americans  AmeriCorps member Population

– Older Americans  AmeriCorps member Population

– People with Disabilities  AmeriCorps member Population

– Rural Residents  AmeriCorps member Population

– Veterans, Active Military , or their Families  AmeriCorps memb er Population

– Economically disadvantaged young adults/Opportunity

Youth  AmeriCorps member Population

– None of the above  Geographic Focus

– Rural  Geographic Focus

– Urban  Encore Program  Faith - and community - based organizations  Governor and Mayor Initiati ve  SI G/Priorit y Schools  Professional Corps  21 st 

### CSC  Other  Percentage of MSYs in Tier 1 Performance Measures  

### Percentage of MSYs in Tier 2 Performance Measures