# FY2013 **AmeriCorps State and National SCHOOL TURNAROUND AM**  **ERICORPS APPLICATION INSTRUCTIONS**  **Competitiv e**  **including :**  AmeriCorps Indian Tribes AmeriCorps National Direct AmeriCorps National Education Awards Program State Commission AmeriCorps State Competitive State Commission AmeriCorps State Competitive Education Awards Program AmeriCorps State Competitive Direct (if applicable) AmeriCorps State Competitive Direct Education Award s Program (if applicable)

**OMB Control #: Expiration Date:** 2



## IMPORT **AN T NOTICE**  These application instructions conform to the Corporation for National and Community Service’s online grant application sy stem, eGrants . All funding announcements by the Corporation for National and Community Service (CNCS) are posted on www.nationalservice.gov and www.grants.gov . **Public Burden Statement:** Public reporting burden for this collection of 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 you: The information requested on the AmeriCorps 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 an y 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 securit y or confidentiality

or information maintained in this sy stem of records, and the information disclosed is relevant and unnecessary for the assistance. Executive Summaries of all compliant applications received and applications of successful applicants will be published on the CNCS website as part of ongoing efforts to increase transparency in grantmaking. This is described in more detail in the Notice of Federal Funding Opportunity. The information will not othe rwise be disclosed to entities outside of AmeriCorps and CNCS without prior written permission. Effects of Nondisclosure
- The information requested is mandatory in order to receive benefits. **Federal Funding Accountability and Transparency Act:** Grant r ecipients 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 sy stems in place to collect and report this information. See 2 C.F.R. Part 170 for more information and to determine how these requirements apply
. **Universal Identifier:** Applications must include a Dun and Bradstreet Data Universal Numbering Sy stem (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
.3



## TABLE OF CONTENTS Important Notice
................................ ................................ ................................ ................................ **Guidance for State Commissions**  **................................ ................................**  **................................ ....**  **Application Resources ................................**  **................................ ................................**  **..................... Submitting Your Application in eGrants**  **................................ ................................**  **......................** I. Applicant Info
................................ ................................ ................................ ..................... II. Application Info
................................ ................................ ................................ .................. III. Narratives
................................ ................................ ................................ ............................ IV . Performance Measures
................................ ................................ ................................ ........ V. Documents ................................ ................................ ................................ .......................... VI . Budget Instructions
................................ ................................ ................................ ............. VII . Subapplications ( AmeriCor ps National Onl y)
......... ................................ ............... ........ VIII. Review, Authorize, and Submit
................................ ................................ .......................... **Tables** Table 1: Requirements in the AmeriCorps Regulations
................................ ................................ ... Table 2: Match Requirements in the AmeriCorps Regulations
................................ ........................ **ATTACHMENTS These Attachments are Worksheets only. All**  **information must be entered in eGrants.** A. SF - 424 Facesheet (eGrants Applicant Info and Application Info Sections)
................................ ............................. B . Performance Measure Instructions for New/Re
- competing Applicants (eGrants Performance Measures Section)
................................ ................................ .......................... C . Detailed Budget Instructions
................................ ................................ ................................ ........ D . Budget Worksheet
................................ ................................ ................................ ........................ E . Detailed Budget Instructions for Fixed
- Amount Grants ................................ .............................. F . Fixed
- Amount Budget Worksheet
................................ ................................ ............................... G . Budget Checklist
................................ ................................ ................................ .......................... H . Alternative Match Instructions
................................ ................................ ................................ .... I . National Operating Site Worksheet..................................................................... J . Beale Codes and County
- Level Economic Data
................................ ................................ ........... K . Assurances and Certifications (eGrants Authorize and Submit Section)
................................ .... L . Benefic i ary

Populations /Grant Characteristics (eGrants Performance Measures Section)
... ...... ... .................................. .................. .4 GUIDANCE FOR STATE COMMI SSI ONS Each State Commission is responsible for developing an application process that includes the review and selection of AmeriCorps programs for submission to CNCS for funding. State Commissions may

choose not to solicit applications for funding under the School Turnaround AmeriCorps Notice for Funding ( Notice ) . In this case, single
- state appicants may apply directl y to CNCS. **State Commissions must notify CNCS bv XX**  **, 2013 if they are accepting single**  **- state**  **applications :**  **Requirements for Competitive Submission** A State Commission Prime Application Package(s) for School Turnaround AmeriCorps funding must include :  Applicant in formation from the State C ommission (prime application).  Assurances and Certifications signed b y the appropriate authorizing official.  The AmeriCorps State and National program applications you are recommending for funding.  Commission ranking of applications as outlined in the AmeriCorps regulations 45 CFR § 2522.465.  Recommendation summaries for each application submitted. In addition, State C ommissions are responsible for ensuring that each recommended application complies with all of the submission requirements set forth in the Notice and Application Instructions. This means that in addition to the p rime and sub
- applications, the C ommission will ensure that required document s, (e.g. Evaluations, and Labor Union Concurrences ) will also have been submitted to CNCS by the submission due date, if applicable. **Do not submit supplementary materials not requested in the Application Instructions or the**  **N otice**  **. CNCS will not review or return them. State Competitive New or Re**  **- Compet**  **ing Selection Process** This is to assist you in developing your C ommission specific application materials and developing your selection processes
. State C ommissions must follow state law requirements regarding requests for proposals and the selection of programs within their state. Commission outreach and review processes should be consistent with board approved policies and may be run concurrently

with formula or other competitions. Commissions should provide information on the following topics to program applicants:  Funding availability
.  List grants t ypes available under the Notice .  State maximum cost per MSY and budget guidelines.  State priorities.  CNCS priority

areas.  Selection criteria.  Other information the C ommission or state may require.5

The State C ommission is responsible for:  Notifying CNCS to report if they are soliciting applications for this funding opportunit y or if they will instruct single
- state applicants to appl y directly to CNCS.  Submission of School Turnaround AmeriCorps State Competitive applications to CNCS for funding consideration.  Thoroughl y reviewing the recommended applications to ensure they are complete, accurate, and in compliance with all program and budget requirements before submitting them to CNCS in eGrants.  Preparing ranking and recommendations for new/re
- competing programs to fund.  Reviewing Federal Financial Reports to monitor and report on re
- competing programs’ progress toward the matching requirements stipulated in the AmeriCorps rule 45 CRF §§ 2521.35 - 2521.9 1.  Reading, understanding, and signing all assurances, certifications, and restrictions, including the certification of each program’s progress toward the matching requirements.  Assessing a program’s request for an Alternative Mat ch Schedule and submitti ng the C ommission’s assessment and recommendation to CNCS for any program they

are including on their prime application.  Assessing an y other requests for all owable waivers, developing the C ommission’s recommendation for the waiver and submitting the materials to CNCS for consideration. **Commission Review Requirements** Commissions are required to conduct a competitive review to assess new and re
- competing state competitive grant applications. Commissions must certify in eGrants that the selection process c omplied with the National and Community Service Act of 1990 (NCSA), as amended, AmeriCorps regulations, and all state laws and conflict of interest rules. The AmeriCorps regulations, 45 CFR § 2522.460 and § 2522.475 , describe the extent to which C ommissions must use CNCS selection criteria and priorities when selecti ng programs and to what extent C ommissions may consider priorities other than those stated in the regulations or in the Notice . Include the criteria the C ommission will use to evaluate and select applications in yo ur application materials. **State Commission Ranking and Recommendation Summaries** The AmeriCorps regulations, 45 CFR § 2522.465, include requirements regarding ranking applicants for State Competitive funding, including competitive planning grants. Submit the rankings in eGrants using the “Manage Subs” screen in the prime application to enter information on each of the new or re
- competing sub
- applications. Once the information for each sub
- application has been entered, save and close. The main Manage Subs page will now include all subs listed under “For Competitive Submissions” with a “R ank: Select a Rank” drop down menu next to each. Provide rankings in order of funding priority in the sub
- applications section of the Competitive Prime Application in eGrants. Each ranked program must have a different rank (i.e., no “ties”).If a state is responding to more than one Notice and thus will rank the programs in each Notice , please note applicant rank order in the Commission R ank Justification field of the C ommission competitive Prime Application.6

Summarize the criteria and process used b y the C ommission to arrive at the submitted rankings in the Commission Rank Justification field of the C ommission Competitive Prime Application. There is a character limit of 1,000 characters. For each new and re
- competing School Turnaround AmeirCorps comp etitive application that is being submitted to CNCS , provide a “Recommendation Summary” including the information listed below:  Provide a summary

of the program’s service activities.  Describe the program’s strengths and how it will complement the C ommiss ion’s existing portfolio and address needs identified in the State Service Plan.  Discuss potential challenges to success and the C ommission’s strategy for meeting the challenges through training and technical assistance.  For re - competing programs, review the most recent financial report, list the overall percentage of match, and provide the C ommission assessment of the program’s ability t o meet its match.  For re - competing programs, discuss any p rogrammatic compliance issues, including enrollment, retenti on, performance and progress toward impact. If programmatic issues are identified, describe how the program will a ddress them and what steps the C ommission will take to ensure success.  For re - competing programs, discuss each program’s record for submittin g forms and reports in a timely

m anner (including 30 - day e nrollment, 30 - day

e xits, fiscal reporting deadlines, and progress reporting deadlines).  For re - competing programs, provide either an assessment of each program’s evaluation efforts to date or a completed evaluation, as applicable. **Matching Requirements** The State C ommission is responsible for meeting an aggregate overall match requirement based on the subgrantees’ individual match requirements. See 45 CFR §§ 2521.50
- 2521.90 and additional guidance from CNCS for the matching requ irements that appl y t o a given C ommiss ion and its sub
- grants. Section 121(e) of the National Community Service Act (NCSA) requires that grantees that use other federal funds as match for an AmeriCorps grant report the amount and source of these funds to CNCS . I f a grantee uses federal funds as match, they will be required to report the sources and amounts on the FFR. **State Commission One Percent Fixed Administrative Cost Option** While CNCS encourages State Commissions to provide the full five percent to subgrantees for administrative costs, C ommissions may require subgrantees to allocate up to one
- fifth of the five percent (i.e., one percent of the federal dollars awarded) to be retained b y the C ommission to cover commission
- level administrative costs. Any admini strative funds retained by the C ommission must be used solely in support of the AmeriCorps programs from whic h they have been retained. The C ommission’s accounting s ys tem must track and allocate these administrative funds separatel y.7



## Ap **plication Resources** If your proposed grant will be used to develop a program that will operate solely within one state, and you are not an Indian Tribe, you **must** contact your state service commission for funding information . The state service commission (commission) will provide you with the appropriate application materials and inform you of its application deadline. A single
- state applicant may

be instructed by

a State Commission to apply directly to CNCS if they

are not accepting applications for this Notice. A list o f all State Service Commissions can be found here: http://www.americorps.gov/about/contact/statecommission.asp
. Please use these Application Instructions to apply directly to the Corporation for National and Community

Service (CNCS) **only if** yo u are a new or re - competing applicant applying for School Turnaround AmeriCorps grants: Indian Tribes, National Direct, National Education Awards Program or are a single
- state applicant that h as been instructed b y a State Commission
. Use these instructions in conjunction with the **2013 School Turnaround AmeriCorps** Notice of Federal Funding Opportunity (Notice) , and the AmeriCorps Regulations, 45 CFR §§ 2520

–2550. **The Notice**  **includes deadlines , letter of intent to apply requirements, eligibility**  **requirements, submission requirements, maximum amount of funding per Member Service Year (MSY),**  **1 and other information.**  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 AmeriCorps Regulations** Topics Citation in the AmeriCorps Regulations Member Service Activities §2520.20 - §2520.55 Prohibited Activities §2520.65 Tutoring Programs §2522.900 - 2522.950 Matching Funds §2521.35 - 2521.90 Member 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 an y inconsistency between the AmeriCorps regulations, the Notice, and the Application Instructions, the order of precedence is as follows: 1. AmeriCorps regulations 45 CFR §§ 2520

–2550 take precedence over the 2. Notice of Federal Funding Opportunit y , which takes precedence over the 3. Application Instructions.

1 One MSY is equivalent to 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.8



## Submitting Your A **pplication in eGrants** 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 s tarting Section I you will need to:  Start a new Grant Applicat ion  Select a Program Area (AmeriCorps)  Select a NOFA: Indian Trib es s elect: School Turnaround AmeriCorps Indian Tribes FY 2013 Multi
- State applicants s elect one of the following :  School Turnaround AmeriCorps National Direct FY 2013  School Turnaround Ameri Corps National Education Awards Program (EAP) FY 2013 Single
- State a

pplic ants s elect one of the following :  School Turnaround AmeriCorps Commission State Competitive FY 2013  School Turnaround AmeriCorps Commission State Competitive Education Awards Program (EAP) FY 2013  School Turnaround AmeriCorps State Competitive Direct FY 2013 (Single
-state applicants should only use this if instructed by their State Commissions
.)  School Turnaround AmeriCorps State Competitive Direct Education Awards Program (EAP ) FY 2013 (Single
-state applicants should only use this if instructed by their State Commissions .) Your application consists of the following components. M ake sure to complete each section. I. Applicant Info II. Application Info III. Narratives IV . Performance Measures V. Documents VI . Budget VII. Review, Authorize, and Submit **I. Ap**  **plicant Info** In formation 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 appl yi ng for the first time or for a different project, have only received formula funding in the past, or are a former grantee (non
- formula) whos e last AmeriCorps grant was received more than five years ago, select **New** .  If you are a current planning grantee appl yi ng for a three
- year implementation grant, select **New** .9

 If you are a current grantee (in ye ar three of a competitive three
- ye ar funding cycle and applying for a new three
- ye ar grant for the same project), select **Renewal** .  If you are not a current grantee, but have received a competitive AmeriCorps grant in the past five years for the same project, select **Renewal** .  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 b y 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. F or city or county

inf ormation, p lease follow each one with the two
- letter capitalized state abbreviation.  Requested project period start and end dates. You may not request a program start date earlier than **August 1st .**  First
- time grantees should not expect to start until late summer or earl y fall. The project period is three years.  Indicate Yes or No i f you are delinquent on an y federal debt. If yes, send explanation as described in Section V.D.  State Application I dentifier: Enter N/A.  The a pplication is not subject to r evie w b y 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 ty pe 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.  The “Estimated Funds Requested” box will be populated automaticall y after you complete the budget. 

### III. Narratives The page limitation will be specified in the Notice. The narrative s section of the application is yo ur opportunity

to convince reviewers that your project meets the selection criteria. Below are some general recommendations 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 your proposed program description to fit each fundin g priority 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 your 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 you are proposing.  **Explain how.** Avoid simply stating that the criteria will be met. Explicitly describe how the proposed project will meet the criteria.10

 **Don’t make assumptions.** Even if you have received funding from CNCS in the past, do not assume your reviewers know any thing about you, your proposed program, your partners, or your benefi ciaries. Avoid overuse of acron ym s.  **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 order 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 Effectiven ess and Budget Adequacy
.  Evaluation Plan. Note: T he Narratives Section also includes fields for Clarification Information, Amendment Justification, and Continuation Changes. **Pl ease enter N/A in these fields.**  **They will be used at**  **a later date to enter information for clarification following review,**  **to request amendments**  **once a grant is awarded, and to**  **enter changes in the narrative in continuation requests.** Reviewers will assess your application against the selection criteria. To best respond to the criteria listed in the Notice and Application Instructions , we suggest that yo u include a brief discussion of each bullet if it pertains to your application. **A. Executive Summary** Please provide a one
- paragraph executive summary of your proposed program. This summary should be one - half page or less
. The summary should include who, what, where, when, and why :  Who will be serving? Who will be served?  What will the AmeriCorps members do ?  What is the expected outcome (s) of the project ?  What is the CNCS investment? What is the match amount?  Where will the activity take place?  When does the project begin and end?  Why is this a good investment? You may fill in the blanks in the following template to complete your executive summary . [Number of] AmeriCorps members will leverage an additional [number of leveraged volunteers, if applicable] to [what the members will be doing] in [where they will be working] . At the end of the [duration of project ] period, [anticipated outcome o f project] . This project will focus on the CNCS focus area of [Focus Area(s) ] . The CNCS investment of $[amount of request] will be matched with $[amount of projected match]. CNCS will post these summaries on **www.nationalservice.gov** in the interest of transparency and Open Government.11

**B. Selection Criteria** Each application must clearl y 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)**  Describe your approach to addressing the need or problem described in the Notice. Reviewers will examine the degree to which the app licant demonstrates how AmeriCorps members are particularl y well
- suited to solving the identified community problem. Applicants should address the following: What are your expected outcomes and how will you measure them? Which CNCS focus areas and nati onal measures are you selecting, if applicable? What is the connection between the community

need(s) you describe and the approach you are proposing? How you collaborated with community

partners to identify

the need and activities? What do you plan to do? Where and when? Please include a timeline. Also address the following:  Who will be the beneficiaries of this proposed project?  Where will the activities take place? Provide a list of service locations.  Why will this approach be successful and why is it mo re promising than other alternative approaches?  How will AmeriCorps members be recruited, trained, and supervised?  Why should CNCS invest in the project? **1. Organizational Capability (25 percent)**  Describe your capacit y t o plan, implement, manage, and evaluate the proposed program. Reviewers will assess the extent to which the applicant demonstrates organizational background and staffing to ensure sustainability , compliance , accountability , continuous improvement, and consultation with State Commissions . Also address the following: **Ability to Provide Program Compliance Oversight.** Describe the experience and infrastructure yo ur organization has in managing similar programs. Demonstrate compliance with AmeriCorps program requirements (for current and form er grantees). **Ability to Provide Fiscal Compliance Oversight.** Describe the experience and infrastructure yo ur organization has in managing grants. What is your current organizational budget? What percentage of the budget would this grant represent? How will you ensure compliance with Federal requirements? **2. Cost**  **- Ef**  **fectiveness and Budget Adequacy (25 percent)** For cost - reimbursement grants, reviewers will assess the extent to which:  The budget is clear, reasonable, cost
- effective, and in alignment with the program narrative.  The requested funds do not exceed the maxi mum cost per MSY , or for existing programs, have not increased over previous y ears unless warranted
.12

 Whether the program is a cost
- effective approach for addressing the community need(s) identified in the application.  The applicant’s demonstrated understanding of total program cost necessary to support the project and the capacity to raise the additional resources. For Education Award Programs ( EAPs ) or other Fixed
- amount grants, reviewers will also assess:  The applicant’s demonstrated understanding of to tal program cost and capacity to raise the additional resources beyond the fixed
- amount provided b y CNCS . **C. Evaluation Summary or Plan** If you are competing for the first time, please enter N/A in the Evaluation Summary or Plan field because it pertains only

to re - competing grantees. If you are re - competing for AmeriCorps funds for the first time you must submit a summary of your evaluation efforts or plan to date in the Evaluation Summary

or Plan field in eGrants. If you are re - competing for a subsequent time, you must submit your evaluation report according to the instructions in section V. E ., below. An evaluation report may

be submitted in place of an evaluation plan. Your evaluation requirements differ depending on the amount of your gr ant, as described in the AmeriCorps Regulations, Section 2522.710:  If you are a State and

/or National grantee (other than an EAP grantee), and your average annual CNCS program grant is $500,000 or more, you must arrange for an external evaluation of your p rogram, and you must submit the evaluation with any application to CNCS for competitive funds as required in §2522.730 of this subpart.  If you are a State and

/or National grantee whose average annual CNCS program grant is less than $500,000, or an EAP grantee, you must conduct an internal or an external evaluation of yo ur program, and you must submit the evaluation with any application to CNCS for competitive funds as required in §2522.730 of this subpart. A formula program will be consi dered a re
- competing application if it satisfies the CNCS definition of “same project ” below, and has been funded in formula for at least one three
- ye ar cycle. If your project satisfies the definition of same project, and you have completed one three
ye ar cycle, you will be required to submit an evaluation plan, summary , or evaluation report when you recompete for the first time. If your project does not satisfy the definition, it will be considered new and will not be required to submit an evaluation plan, summary , o r completed evaluation. Two projects will be considered the same if they :  A ddress the same issue areas
.  A ddress the same priorities
.  A ddress the same objectives
.  S erve the same target communities and population
.  Utilize the same sites
.  U se the same program staff and members. **D. Amendment Justification** Enter N/A. This field will be used if you are awarded a grant and need to amend it.13

**E. Clarification Information** Enter N/A. This field will be used to enter information that requires clarification in the post
review 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 yo ur continuation requests. 

### IV. Performance Measur**es** 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 P opulation

– Communities of Color  AmeriCorps M ember Population

– Lo w - income individuals  AmeriCorps M ember Population

– Native Americans  AmeriCorps M ember Population

– New Americans  AmeriCorps M ember Population

– Older Americans  AmeriCorps M ember Population

– People with Disabilities  AmeriCorps M ember Population

– Rural Residents  AmeriCorps M ember Population

– Veterans, Active Military , or their Families  AmeriCorps M ember Population

– Economically disadvantaged young adults/ Opportunity

Youth  AmeriCorps M ember Population

– None of the above  Geographic Focus

– Rural  Geographic Focus

– Urban  Encore P r ogram  Faith
- and community
- based organizations  SI G/Priorit y Schools All applicants must submit performance measures with their application. See Attachment B fo r instructions for entering performance measures
. For more information about Performance Measures go to: http://www.nationalserviceresources.org/star/ac For more information about the Natio nal 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 federall y - approved indirect cost agreement (if budgeted by multi
- state applicants and Tribes only), and a letter (s) of support as described in the Notice . After you have submitted the documents, change their status in eGrants14

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 you have submitted a completed evaluation plan or report
. If an evaluation is required, you must submit a cop y at the time of application eve n 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 emplo yees engaged in the same or substantially similar work as that proposed to b e carried out b y 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 organization representing those employees. Written concurrence can be in th e 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

similar work as employees represented by a local labor organization , then the applicant must submit a written description of how it will ensure that : i) AmeriCorps members will not be placed in positions that were recently occupied by paid staff

. ii) No AmeriCorps member will be placed into a position for which a recentl y resigned or discharged employ ee has recall rights as a result of a collective bargaining agreement, from which a recentl y resigned or discharged employee was removed as a result of a reduction in force, or from which a recently resigned/discharged employee is o n leave or strike. For the purposes of this section, “program applicant” includes an y applicant to CNCS or a State Commission, as well as any entit y appl yi ng for assistance or approved national service positions through a CNCS grantee or subgrantee. I f either 1) or 2) above applies to you, please select “Enter New,” name the new document 1) “Labor Union Concurrence,” or 2) “Displacement Assurance” and select “Sent.” **C. Federally -**  **approved Indirect Cost Agreement** Multi
- state and Indian Tribes a pplicants 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. Single state applicants please contact your State Commission for Indirect Cost Agr eement submission instructions.15

**D. Delinquent**  **on Federal Debt** Any applicant that check s Yes to the question on federal debt delinquency must submit a complete explanation. **E . Submission Instructions for Evaluations, Labor Union Concurrence**  **, Indirect Cost Rate**  **Agreements , and Letter**  **(s) of Support**  **.** Please submit the required documents to americorpsgrants@cns.gov . This infor mation must be received at CNCS by

5 p.m. Eastern Time on the deadline
. Include the name of the document and organization in the file name. Letters of Support should be submitted as a single document and not multiple files. Single
- state applicants please contact your State Commission for submission instructions. Or, you may send hard copy information to: Corporation for National and Community Service ATT: **School Turnaround AmeriCorps** 1201 New York Avenue NW Washington, DC 20525 Please use an alternat ive service to the U.S. Postal Service to send hard copy . U.S. Postal Service deliveries to government agencies often are delayed and sometimes damaged due to securit y measures. Attach a hard copy of the program’s SF424 Facesheet to each document so that w e know which application corresponds to each document. Documentation submitted without the SF 424 will not be considered.16



### VI. **Budget Instructions For Fixed**  **- Am**  **ount grants: Use the Budget Instructions for Fixed**  **- Amount applicants**  **(Attachment E**  **) and the Budget Worksheet**  **( Attachment**  **F )**  **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 Requirements in the AmeriCorps Re gu**  **lations Competition**  **Match Requirement** State and National Competitive 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 and any year thereafter. 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 and any ye ar thereafter. State and National 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.
 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 ye ars, and the increasing minimums in years thereafter, are maintained. See 45 CF R §§ 2521.35

–2521.90 for the specific regulations.  If you are appl yi ng 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 re - competing, 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 separatel y. Include dollar amount , the match classification (cash, in
- kind, or Not Available) and the source t ype ( P rivate, State/L ocal, F ederal , Other or Not Available)
. Define all acron ym s the first time they are used.  See Attachment H for instructions for appl yi ng for the Alternative Match Schedu le. 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 Act 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.17

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 Adeq uacy selection criterion. Follow the detailed budget instructions in Attachment C to prepare your budget. We recommend that you prepare your budget in the same order as indicated in the Budget Worksheets in Attachments C and D . As you enter your detail ed budget information, eGrants will automatically populate a budget summary and budget narrative report. Prior to submission be sure to review the budget checklist (Attachment G ) to ensure your budget is compliant. In addition, eGrants will perform a limit ed compliance check to validate the budget. If it finds any compliance issues you will receive a warning and/or error messages. You must resolve all errors before you can submit your budget. As you prepare your budget:  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 are 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 circ ulars are online at www.whitehouse.gov/OMB/circulars.  A - 21 - Cost Principles for Educational Institutions, 2 CFR 220  A - 87 - Cost Principles for State, L ocal, 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 laws, 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 Circular A
- 133. 

### VII. **Subapplications ( AmeriCorps**  **National Only**  **)** Multi
- state programs are required to provide identifying information and budgets for each site, including the organization’s name, EIN and DUNS numbers, organization ty pe, organizational characteristics, and contact information. Appendix I is a worksheet you can use to prepare to enter identifying i nformation for your sites. The capability to enter this information in eGrants does not exist at this time. Please compile the information requested in the instructions, including budget and Appendix Iand be ready to submit this information upon request. Enter the following budget information :18

 Section I : Program Operating Costs, I. Other Program Operating Costs: Please put all yo ur program’s expenses in one line entitled Program Costs
.  Section II : Enter all member costs per the Instructions in Attachme nt C  Section III: Enter administrative/indirect costs per the Instructions in Attachment C . 

### VIII. **Rev iew**  **, A uthorize, and Submit**  eGrants requires that you review and verify your entire application before submitting, by completing the following sections in e Grants:  Review  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 design ee and must have an active eGrants account to sign these documents electronically . An Authorized Representative is the person in your organization authorized to accept and commit funds on behalf of the organization. A cop y 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 el se 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 name will overri de an y 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.**  In dividuals 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.”19



### 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. It em

4. a: Leave blank. It em 4. b: If you are a recipient in year 2 or 3 of an already
- awarded 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 the 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 see**  **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. The 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. It em

7. a.: Enter the appropriate letter in the box. It em 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 - ye ar College 18 Statewide Association 7 4 - ye ar 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 31 U.S. Territory 27 State Commission/Alternative Administrative Entity20

8. Check the appropriate box for type of application and enter the appropriate letter(s) in the lower boxes:  Check “New” if your organization has never held a competitive AmeriCorps State or National grant before. If your organization had a state formula grant, check “New.”  Check “New Application/Previous Grantee” if your organizatio n has held an AmeriCorps State or National grant in the past and this application is for a new grant.  Check “Continuation” if you are a grantee applying for an additional year of funding within an existing multi
- year grant project period. AmeriCorps State and National grants are typically awarded for three
- year periods. 9. Filled in for your convenience. 10. Use the following list of CFDA (Catalog of Federal Domestic Assistance) numbers for the applicable program listing, or other source if so instruc ted in the Notice : 94.006 AmeriCorps State and National. 11. Enter the project title. a. When applying for a “Continuation” or “Amendment” applicants should 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 lett ers 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. 13. (See item 8) “New” applicat ion or “New application/previous grantee:” Enter the dates for the proposed three
- year project period. “Continuation” or “Amendment” application: Enter the dates of the approved three
- year 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 budge t 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 award, 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 amo unt 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** The amount of the applicant share that is coming from income generated by21 **Income** 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. 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 who signs this form must b e the applicant’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 concealment of a material fact, or submission of false,**  **fictitious or fraudulent statements or representations to any department or agency of the United States**  **Government may result in a fine of not more than $10,000 or imprisonment for not more than five (5) years, or both.**  **(18 U.S.C. § 1001)**22 **APPLICATION FOR FEDERAL ASSISTANCE** Standard Form 424 (Rev. 2
- 2007) Prescribed by OMB Circular A
- 102 **1. TYPE OF SUBMISSION:**  Application Non - Construction **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 (DEPARTMENT/DIVISION): 5. e. NAME AND TELEPHONE NUMBER OFP ERSON TO BE CONTACTED ON MATTE RS INVOLVING THIS APPLICATION (give area code): 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 - MAIL

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. 1237 2 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:23



### AT **TA CHMENT**  **B : Performance Measures Instructions**  **(eGrants Performance Measures Section** 

## )

**eGrants Performance Measures Module Instructions About the Performance 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. **Home 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, obje ctives, 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 your measures. To edit a performance measure, click the “ E dit” button. To delete 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 yo ur program des ign. 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 focus24

areas. Select “other” for your focus area and/or objective if your 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. Onl y the focus areas that correspond to the objectives you 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 your primary intervention. You may select a secondary

focus area and 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 alloc ation of MSYs and slots across the focus areas and objectives you have selected. Begin b y entering the total MSYs for your program . 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 members 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. Itis acceptable for slots in this table to exceed total slots requested in the application d ue to double counting members’ service across multiple objectives. **Performance Measure Tab** This tab allows 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.25

Briefl y describe the problem your program will address in this performance measure. Select the intervention(s) to be delivered b y 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 yo u do not wish to select National Performance Measures, you may create an applicant
determined output by

clicking “Add User Output.” Select outcome(s). If yo u 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
- down 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 yo u 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. L ater you can return to this tab to create additional aligned performance measures. **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.26

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. I f you would like to continue to the next step of the module, click “Next.” **Summary Tab** The summary

tab shows all of the information yo u have entered in the module. 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 Measure 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.27



### AT **TA CHMENT**  **C : Detailed Budget Instructions**  **(eGrants Budget Section)**  **Section I. Program Operating Costs** Complete 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 separatel y 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 a pplication 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 performed b y 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 Fr inge Benefits**  Under “Purpose/Description,” identify the t yp es of fringe benefits to be covered and the costs of benefit(s) for each staff position. Allowable fringe benefits ty picall y include FICA, Worker’s Compensation, Retirement, SUTA, Health and Life Insurance, IRA, and 401K. You may provide a calculation for total benefits as a percentage of the salaries to which they apply or list each benefit as a separate item. If a fringe benefit amount is over 30%, please list covered items separately and justify the high cost . Holiday s, 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 wil l travel. Provide a calculation that includes itemized costs for airfare, transportation, lodging, per diem, and other travel
- related expenses multiplied by

the number of trips/staff. Where applicable, identify the current standard reimbursement rate(s) of the organization for mileage, dail y per diem, and similar supporting information. R eimbursement 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 ex pect**  **State Commissions and National Direct applicants to include funds in this line**  **item 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 Institute and the Annual Grantee Meeting in Washington**  **, DC in the fall** 
. Please itemize the costs. For example: Two 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
.28

**C. 2. Member 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 propert y having a useful life of more than one year AND an acquisition cost of **$5,000 or more per unit**  (including accessories, attachments, and modifications). 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. **E. Supplies** 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 more. Except for safety equipment, gr antees may onl y charge the cost of member service gear to the federal share if it includes the AmeriCorps logo. Grantees may also add the AmeriCorps logo to their own local program uniform items using federal funds. Please note that your program will be us ing the AmeriCorps logo in the budget description. All safet y gear may

be charged to the federal share, regardless of whether it includes the AmeriCorps logo. All other service gear must be purchased with non
- CNCS funds. **F. Contractual and Consultant Se rvices**  In clude costs for consultants related to the project’s operations, except training or evaluation consultants, who will be listed in Sections G. and H., below. **G. 1. Staff Training** In clude the costs associated with training staff on project require ments 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, indicate the estimated daily rate. **G. 2. Member Training** In clude 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 AmeriCorps. If using a consultant(s) for training, indicate the estimated d aily rate, not to exceed the daily rate limit. **H. Evaluation** In clude 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 /weekl y gathering of data to assess progress toward meeting performance measures, but is a larger29

assessment of the impact your project is having on the community , as well as an assessment of the overall s ys tems 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:  Criminal 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 pay ment from the grant (federal or non
- federal share).  Office space rental for projects operating without an ap proved 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.  Utilities, telephone, i nternet an d similar expenses that are specificall y 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. L ist each item and provide a justification in the budget narrative. Gifts and/or food in an entertainment/event setting are not allowable costs.  Mu lti
- state applicants: Indicate the number of subgrants and the average amount of subgrants. Indicate an y match that you will require of your subgrants under the “grantee share” column in this category . Subgranted funds may onl y cover costs allowable under federal and AmeriCorps regulations and provisions. **Section II. Member Costs** Member Costs are identified as “Living Allowance” and “Member Support Costs.” Your required match can be federal, state, local, or private sector funds. **A. Living**  **Allowance** The narrative should clearly identify the number of members you are supporting by category (i.e., full
- time, half

- time, reduced
- half

- time, quarter
- time, minimum
- time) and the amount of living allowance they

will receive, allocating appropriate po rtions 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 avera ge amount of the living allowance for each type of member. In addition, enter the number of members for which yo u 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 must pay FICA for any

member receiving a living allowance, even when CNCS does not supply the livin g allowance. If exempted, please30

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 req uire 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 worke r’s compensation, you 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 Ame riCorps 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 capacit y 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 Costs.** Include any other required member support costs here. Some states require unemploy ment coverage for their AmeriCorps members. You may not charge the cost of unemploy ment insurance taxes to the grant unless mandated b y state law. Programs are responsible fo r 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 overall 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, administrativ e costs mean those costs that are included in the organization’s indirect cost rate agreement. Such costs are generall y 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 federall y 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 l ines in this category
. **A. CNCS**  **- Fixed Percentage Method**  **Five Percent Fixed Administrative Costs Option** The CNCS - fixed percentage rate method allows you to charge administrative costs up to a cap without a federally

approved indirect cost rate and without do cumentation supporting the allocation. If you choose the CNCS - fixed percentage rate method (Section IIIA in eGrants), you31

may charge, for administrative costs, a fixed 5% of the total of the CNCS funds expended. In order to charge this fixed 5%, the grante e match for administrative costs may not exceed 10% of all direct cost expenditures. 1. To determine the maximum CNCS share for Section III: Multiply the sum of the CNCS funding shares of Sections Iand II by 0.0526. This is the maximum amount you can reque st as CNCS 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 y et 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 CNCS and grantee share) of Sections I and II b y 10% (0.10) and e nter this amount as the grantee share for Section III A. 3. Enter the sum of the CNCS and grantee shares under 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 the subgrant budget, one - fifth (20%) of the federal dollars budgeted for administrative costs is allocated to the commission’s share and four
- fifths (80%) of the federal dollars budgeted for administrative costs are allocated to the program’s share. The allocation 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 your administrative costs, including the 5% maximum payable b y CNCS . Specify the Cost Ty

pe for which your organization has current documentati on on file, i.e., Provisional, Predetermined, Fixed, or Final indirect cost rate. Suppl y 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 whe ther or not to claim your entire IDC rate to calculate administrative costs. If you choose to claim a lower rate, please include this rate in the Rate Claimed field. 1. Determine the base amount of direct costs to which you will appl y the ID C rate, inclu ding both the CNCS and Grantee shares, as prescribed by your established rate agreement (i.e., based on salaries and benefits, total direct costs, or other). Then multiply the appropriate direct costs by the rate being claimed. This will determine the tota l amount of indirect costs allowable under the grant.32

2. To determine the CNCS share: Multiply the sum of the CNCS funding share in Sections I and II b y 0.0526. This is the maximum amount you can claim as the CNCS share of indirect costs. If a C ommissio n elects to retain a share of the 5% of federal funds available, please note the percentage or amount in the text. There is no separate line item to show this calculation.
3. To determine the Grantee share: Subtract the amount calculated in step b ( the C NCS 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 brief 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 or Not Available) **for your entire match.**  Define any acrony ms the f irst time they

are used.33



### AT **TA CHMENT**  **D : 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** 

Totals34

**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** 35

**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:**36

**Section III. Administrative/Indirect Costs A.**  **CNCS -**  **fixed Percentage Rate** Purpose Calculation **Total Amount CNCS Share**  **Grantee Share**

Totals **B. Federally Approved 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, Amount, Intended Purpose**  **Private State and/or Local**  **Federal Sources**  **In -**  **ki nd**  $ $ $
. **Cash** $ $ $ **Total** $ $ $37



### AT **TA CHMENT**  **E : 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).**  Fixed
- amount Grant applicants may onl y 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. **Budget Section II. AmeriCorps Member Positions Member**  **Positions** Id entify the number of members you are requesting b y 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 column s blank**  . The total number of member service ye ars (MSY) will **automatically calculate** at the bottom of the Member Positions chart. The MSY are calculated as follows:

* Grantees receive the total amount for 2
- Year Half
- time members in the first year. Therefore, 2
- Year Half
- time members serving in their second year are not included in the calculation for funds. Under “Calculation,” yo u will enter the calculation for your grant request. Applicants may request up to $ 800 per member service ye ar (MSY). Display your calculation in the following format: **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**

Total # of MSYs ________ x Cost per MSY amount = Total Grant Request **$____**38



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

**Member Positions 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**  **G : 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 charged 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 expenses 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 f unds m ust be paid out of the funds raised. Development officers 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 perce ntage 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 b ut

are absorbed into the personnel expenses (salary) budget line item? Yes __ No __ The purpose for all staff and member travel is clearly identified? Yes __ No __ You have budgeted funds for staff travel to CNCS sponsored meetings in the budget narrative under

Staff Travel? [Not applicable to State Commission Funded Programs] 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 no t 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 __ 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 equipment? Yes __ No __ Are all consultant services budgeted below the maximum federal daily rate of $750/day? Is the daily rate noted in all sections of the budget narrative where consultants are propos ed? 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?40

**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 allow ance. 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? Administrative costs budgeted include the following: (1) indirect costs such as legal staff, central management and support functions; (2) cos ts 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 adminis trative staff not attributable to the time spent in direct support of a specific project. Not applicable to State Commission Funded Programs Yes __ No __ Applicant has chosen Option B

– The maximum grantee share does not exceed the federally

approved rate, less the 5% CNCS share? 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 i dentified in the narrative and in the Source of Match field in eGrants?41



### AT **TA CHMENT**  **H :**  **Al ternative 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 ye ars, and the increasing minimums in years thereafter, are maintained. See 45 CFR §§ 2521.35

–2521.90 for the specific regulations. **Special Circumstance s for an Alternative 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 demo nstrate that your program is either located in a rural county or in a severel y economicall y 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 count y in which the program is located. An y program located in a county with a Beale code of 6, 7, 8 or 9 is eligible to appl y for the alternative matc h requirement. See Attachment J for the Table of Beale codes. **B. Severely Economically Distressed County:**  In determining whether a program is located in a severel y economically distressed count y, CNCS will consider the following list of count y level char acteristics. See Attachment J for a list of website addresses where this publicly available information can be found.  The count y - 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 Analy sis data;  The count y - level povert y rate is equal to or greater than 125 percent of the national average for all counties using the most recent census data; and  The count y - level unemploy ment is above the national average f or all counties for the previous 12 months using the most recentl y available Bureau of Labor Statistics data.  The areas served b y the program lack basic infrastructure such as water or electricity. **C. Program Location** : Except when approved otherwise, CN CS will determine the location of yo ur 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 appl yi ng for this alternative match schedule. You must submit your request for the alternative schedule by the date the AmeriCorps application is due. Until approved for the alternative schedule, programs should base their budget in the AmeriCorps application according to the standard match requirement
. CNCS will review your request in conjunction with your AmeriCorps application and notify you if you qualify

for the alternative schedule . If you quality and are approved for an AmeriCorps grant , CNCS staff will work with you to re - enter yo ur budget into eGrants under the Alternative Match Schedule. The alternative match requirement will be in effect for the upcoming three
ye ar grant cycle.42

**D. Instructions for the Alternative Match Schedule**  **Submit e -**  **mail applications by the**  **application deadline of XX**  **to:**  Single
- s tate Applicants

– contact Commission for submission instructions.  Multi
- state Applicants

– submit to ACAlternateMatchScheduleRequests@cns.gov  State Commissions (on behalf of state programs)

– submit to ACAlternateMatchScheduleRequests@cns.gov **E -**  **mail subject line:** AmeriCorps Alternative Match Request **Send your request in memo format. You must respond to each item**  **below. Please include both the**  **item and your response in your request.**  **1. Basis of Request** a. Id entify

the basis for your request as either a rural county or a severel y economically distressed community

as described above. b. Describe where your program ope rates and include the address of the legal applicant. **2. Rural Counties** c. Describe the economic conditions. d. Confirm that your county has a Beale code of 6, 7, 8, or 9. **3. Economically Distressed Counties:** e. Provide your count y per - capita income, povert y, and unemployment levels. f. Demonstrate that your county per - capita income, poverty , and unemploy ment levels are above or below the national averages. Identify the data source(s) used to make yo ur determination
. g. Provide an y other statistics you deem relevant to demonstrate your count y is economicall y distressed. **4. Program Location:** If you believe the location of your program should not be based on the address of the legal applicant, describe your justificati on for requesting an alternative location(s). **5. Other:** Provide an y other justification and information for your request that is not presented in the responses to the above.43



### AP **PENDIX I**  **: National Operating Site Worksheet (Subapplication**  **Section)** The following information is required for each operating site. Legal Name Employer Identification Number (EIN) DUNS Number Organization Ty

pe* Organization Characteristic* Contact Name Address City / State/ Zip Phone Fax Email Service Categories** Project Title Address City / State/ Zip Phone Fax Email * See Appendix A ** See Appendix B44



### AT **TA CHMENT**  **J : Beale Codes and Count**  **y -**  **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#**  **Metropolitan 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 Completely rural or less than 2,500 urban population, adjacent to a metropolitan area 9 Non - metro Completely 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.45

**Severely Economically Distressed Community** The following table provides the website addresses where the publicl y available information on county - level economic data including per capita income, povert y 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 Economic 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 pove rty 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 incl uding estimates on poverty, per capita income and unemployment by counties, states, and metro areas including Puerto Rico. www.bls.gov/lau/home.htm **Bureau of Labor Statistics’ Local Area Unemployment Statis**  **tics (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 US. www.census.gov/hhes/www/saipe/index.html **Census Bureau’s Smal l Area Poverty**  **Estimates: Provides data on poverty and population estimates by county for all**  **states except Puerto Rico.**46 **WEBSITE ADDRESS EXPLANATION**  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.** 
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 US.** 47



## AT **TA CHMENT**  **K :**  **As surances and Certifications**  **(eGrants Rev iew**  **, Au**  **thorize 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 assurances and certifications listed below will not necessarily result in denial of a grant. Yo u 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 as**  **surance** The assurances and certifications are material representations of fact upon which we rely in determining whether to enter into this transaction. If we later determine that you knowingly submitted an erroneous certification or assurance, in additio n to other remedies available to the federal government, we may terminate this transaction for cause or default. **c) Notice of error in certification or assurance**  You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous when submitted or has become erroneous because of changed circumstances. **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 “prospe ctive 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 submi tting this proposal that if we approve your application you shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transact ion, 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 tie r 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 cov ered 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 prin cipals. You may, but are not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs. **h) Non**  **- assurance in subgrant agreements**  If you knowingly enter into a lower tier covered transaction with a person who is su spended, 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 c ontained 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 pos sessed by a prudent person in the ordinary course of business dealings.48

**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) to ensure proper planning, management, and completion of the project described in this application.
 W ill 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 est ablish a proper accounting system in accordance with generally accepted accounting standards or agency directives.
 Will establish safeguards to prohibit employees from using their position for a purpose that constitutes or presents the appearance of person al or organizational conflict of interest, or personal gain.
 Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
 Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728
- 4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPM’s Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).
 Will comply wi th 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 Educatio n 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 disabil ity (d) The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101 - 6107), which prohibits discrimination on the basis of age; (e) The Drug Abuse Office and Treatment Act of 1972 (P.L. 92
- 255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91
- 616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290dd
- 3 and 290ee
- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscriminatio n 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 wh ose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases.
 Will comply with the provisions of th e Hatch Act (5 U.S.C. 1501
- 1508 and 7324
- 7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.
 Will comply, as applicable, with the provisions of the Davis
- Bacon Act (40 U.S.C 276a and 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 applic able, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93
- 234) which requires the recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.
 Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91
- 190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved state management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C 1451 et seq.); (f) conformity of federal actions to State (Clean Air) Implementation Plans under Section 176(c) o f the Clean Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground49 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 Spe cies Act of 1973, as amended (P.L. 93
- 205).
 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C 1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.
 Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16U .S.C. 469a - l et seq.).
 Will comply with P.L. 93
- 348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.
 Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 - 544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance.
 Will comply with the Lead
- Based Paint Poisoning Prev ention 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 govern ing this program.

 Will comply with all rules regarding prohibited activities, including those stated in applicable Notice, grant provisions, and program regulations, and will ensure that no assistance made available by CNCS 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 responsibility for the operation of a project or program that receives assistan ce 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
- CNCS funds or paid with CNCS 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 Religious 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 CNCS - funded project and paid with CNCS 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 CNCS website at: http://www.us doj.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) wh ich prohibits discrimination on the basis of race, color, or national origin; (b) Title IX of the Education Amendments of 1972, as am ended (20 U.S.C. 1681
- 1683, and 1685
- 1686). which prohibits discrimination on the basis of sex; (c) Section 504 of the Reha bilitation 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 Of fice and Treatment Act of 1972 (P.L. 92
- 255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91
- 616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd
- 3 and 290 ee
- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Ti tle VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 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 part icipants in the program; and (2) community
- based agencies with a demonstrated record of 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 progr am;50  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, t o 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 operati ng 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 requirement s set out in section 177 of the National and Community Service Act of 1990, and in CNCS 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 CNCS 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 participants, 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 ev aluation 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 CNCS , conduct an internal evaluation of the program;

 Will app ly measurable performance goals and 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 are as as required by the CNCS ;
 Will ensure the provision of a living allowance and other benefits to participants as required by the CNCS ;
 Has not violated a Federal criminal statute;

 If a state applicant, will ensure that the State subgrants will be use d 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 f actors 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 agency, unless CNCS approves otherwise.51 **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 certificatio n is required by the CNCS 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 bas is, 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 groun ds 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 grantee, I certify, to the best of my knowledge and belie f, that the grantee will provide a drug
- free workplace by: A. Publishing a drug
- free workplace statement that:

a. Notifies employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grant ee’s workplace; b. Specifies the actions that the grantee will take against employees for violating that prohibition; and c. Informs employees that, as a condition of employment under any award, each employee will abide by the terms of the statement and notify the grantee in writing if the employee is convicted for a violation of a criminal drug statute occurring in the workplace within five days of the conviction; B. Requiring that a copy of the statement described in paragraph (A) be given to each employee who will be engaged in the performance of any Federal award; C. Establishing a drug
- free awareness program to inform employees about: a. The dangers of drug abuse in th e workplace; b. The grantee’s policy of maintaining 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 wor kplace; D. Providing us, as well as any other Federal agency on whose award the convicted employee was working, with written notification within 10 calendar days of learning that an employee has been convicted of a drug violation in the workplace; E. Taking one of the following actions within 30 calendar days of learning that an employee has been convicted of a drug violation in the workplace: a. Taking appropriate personnel action against the employee, up to and including termination; or b. Requiring that the employ ee 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;52 F. Making a good faith effort to continue to maintain a drug
- fr ee workplace through implementation of paragraphs (A) through (E). **Certification -**  **Lobbying Activities** As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that:

 No 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 i n 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 appropri ated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with thi s 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 includ ed in the award documents for all subcontracts at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients will certify and disclose accordingly. **Erroneous certification or ass urance**  The assurances and certifications are material representations of fact upon which we rely in determining whether to enter int o this transaction. If we later determine that you knowingly submitted an erroneous certification or assurance, in addition to other remedies available to the federal government, we may terminate this transaction for cause or default. **Notice of error in certification or assurance** You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous when submitted or has become erroneous because of changed circumstances. **Definitions** The terms “debarment”, “suspension”, “excluded”, “disqualified”, “ineligible”, “participant”, “person”, “principal”, “proposal”, and “voluntarily excluded” as used in this document have the meanings set out in 2 CFR Part 180, subpart I, “Definitions.” A transaction shall be considered a “covered transaction” if it meets the definition in 2 CFR part 180 subpart B, “Covered Transactions.” **Assurance requirement for subgrant agreements**  You agree by submitting this proposal that if we approve your application you shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntaril y excluded from participation in this covered transaction, unless authorized by us. **Assurance inclusion in subgrant agreements** You agree by submitting this proposal that you will obtain an assurance from prospective participants in all lower tier cover ed transactions and in all solicitations for lower tier covered transactions that the participants are not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction. **Assurance of subgrant principals** You may rely upon an assurance of a prospective participant in a lower
- tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless you know that the assurance is erroneous. You may decide the method and frequency by which you determine the eligibility of your principals. You may, but are not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs. **Non -**  **assurance in subgrant agreements** If you knowingly enter into a lower tie r 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 de fault. **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 req uired to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.53

**Certification -**  **Grant Review Process (State Commissions Only)** I certify that in conducting our review process, we have ensured compliance wit h the National and Community Service Act of 1990, CNCS 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 Certifications are: Certification: Debarment, Suspension and Other Responsibility Matters Certification: Drug
- Free Workplace Certification: Lobbying Activities **Organization Name :**  **Program Name :**  **Name and Title of Authorized Representativ e**  **: Signature**  **: Date**  **:**54



### AT **TA CHMENT**  **L :**  **Beneficiary Populations**  **/Grant Characteristics**

 AmeriCorps M ember Population

– Communities of Color  AmeriCorps M ember Population

– Lo w - income individuals  AmeriCorps M ember Population

– Native Americans  AmeriCorps M ember Population

– New Americans  AmeriCorps M ember Population

– Older Americans  AmeriCorps M ember Population

– People with Disabilities  AmeriCorps M ember Population

– Rural Residents  AmeriCorps M ember Population

– Veterans, Active Military , or their Families  AmeriCorps M ember Population

– Economically disadvantaged young adults/Opportunity

Youth  AmeriCorps M ember Population

– None of the above  Geographic Focus

– Rural  Geographic Focus

– Urban  Encore Program  Faith
- and community
- based organizations  SI G/Priorit y Schools