FY2013 AmeriCorps State and National

SCHOOL TURNAROUND AMERICORPS

APPLICATION INSTRUCTIONS

Competitive 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 Awards Program (if applicable)

OMB Control #: Expiration Date: 
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IMPORTANT NOTICE

These application instructions conform to the Corporation for National and Community

Service’s online grant application system, eGrants. All funding announcements by the 

Corporation for National and Community Service (CNCS) are posted on 

www.nationalservice.gov and www.grants.gov. 

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

estimated to average 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 any prior criminal convictions. 

The information may also be provided to appropriate federal agencies and Department 

contractors that have a need to know the information for the purpose of assisting the 

Department’s efforts to respond to a suspected or confirmed breach of the security or 

confidentiality or information maintained in this system of records, and the information disclosed 

is relevant and unnecessary for the assistance. Executive Summaries of all compliant 

applications received and applications of successful applicants will be published on the CNCS 

website as part of ongoing efforts to increase transparency in grantmaking. This is described in 

more detail in the Notice of Federal Funding Opportunity. The information will not otherwise 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 recipients will be required to 

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

executive compensation for recipients and subrecipients. Recipients must have the necessary

systems in place to collect and report this information. See 2 C.F.R. Part 170 for more 

information and to determine how these requirements apply.

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

Numbering System (DUNS) number and register with the Central Contractor’s Registry

(CCR). All grant recipients are required to maintain a valid registration, which must be renewed 

annually.
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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 (AmeriCorps National Only)................................................................

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. Beneficiary Populations/Grant Characteristics

(eGrants Performance Measures Section) .................................................................
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GUIDANCE FOR STATE COMMISSIONS

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 directly 

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 information from the State Commission (prime application). 

 Assurances and Certifications signed by 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 Commissions 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 prime and sub-applications, the Commission will 

ensure that required documents, (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 Notice. CNCS will not review or return them. 

State Competitive New or Re-Competing Selection Process 

This is to assist you in developing your Commission specific application materials and 

developing your selection processes. State Commissions 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 types available under the Notice.

 State maximum cost per MSY and budget guidelines. 

 State priorities. 

 CNCS priority areas. 

 Selection criteria. 

 Other information the Commission or state may require. 
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The State Commission is responsible for: 

 Notifying CNCS to report if they are soliciting applications for this funding opportunity or if 

they will instruct single-state applicants to apply directly to CNCS.

 Submission of School Turnaround AmeriCorps State Competitive applications to CNCS for 

funding consideration. 

 Thoroughly 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 §§ 

2521.35-2521.91. 

 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 Match Schedule and submitting the 

Commission’s assessment and recommendation to CNCS for any program they are including 

on their prime application. 

 Assessing any other requests for allowable waivers, developing the Commission’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 

complied 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 

Commissions must use CNCS selection criteria and priorities when selecting programs and to 

what extent Commissions may consider priorities other than those stated in the regulations or in 

the Notice. Include the criteria the Commission will use to evaluate and select applications in 

your 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 “Rank: 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 Rank Justification field of the Commission 

competitive Prime Application. 
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Summarize the criteria and process used by the Commission to arrive at the submitted rankings 

in the Commission Rank Justification field of the Commission Competitive Prime Application. 

There is a character limit of 1,000 characters. 

For each new and re-competing School Turnaround AmeirCorps competitive 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 Commission’s existing 

portfolio and address needs identified in the State Service Plan. 

 Discuss potential challenges to success and the Commission’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 Commission assessment of the program’s ability to 

meet its match. 

 For re-competing programs, discuss any programmatic compliance issues, including

enrollment, retention, performance and progress toward impact. If programmatic issues are 

identified, describe how the program will address them and what steps the Commission will 

take to ensure success. 

 For re-competing programs, discuss each program’s record for submitting forms and reports 

in a timely manner (including 30-day enrollment, 30-day exits, 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 Commission 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 requirements that apply to a given Commission 

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. If 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, Commissions 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 by the Commission to 

cover commission-level administrative costs. Any administrative funds retained by the 

Commission must be used solely in support of the AmeriCorps programs from which they have 

been retained. The Commission’s accounting system must track and allocate these administrative 

funds separately. 
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Application 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 of 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 you 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 has been instructed by 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),1and 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 any 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 Opportunity, which takes precedence over the

3. Application Instructions.

 

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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 requested in the application. It does not include 

childcare or the cost of the education award.
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Submitting Your Application 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 starting Section I you will need to:

 Start a new Grant Application

 Select a Program Area (AmeriCorps)

 Select a NOFA: 

Indian Tribes select: School Turnaround AmeriCorps Indian Tribes FY 2013

Multi-State applicants select one of the following:

 School Turnaround AmeriCorps National Direct FY 2013

 School Turnaround AmeriCorps National Education Awards Program (EAP) FY 

2013

Single-State applicants select 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. Make 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. Applicant Info

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

the SF 424 Facesheet. If you are submitting your application in hard copy, you will find the 

SF 424 in Attachment A. 

 If you are applying for the first time or for a different project, have only received formula 

funding in the past, or are a former grantee (non-formula) whose last AmeriCorps grant was 

received more than five years ago, select New.

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

New.
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 If you are a current grantee (in year three of a competitive three-year funding cycle and 

applying for a new three-year 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. Application Info

In the Application Info Section enter:

 Areas affected by your proposed program. Please include the two-letter abbreviation with 

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

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

the two-letter capitalized state abbreviation. 

 Requested project 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 

early fall. The project period is three years. 

 Indicate Yes or No if you are delinquent on any federal debt. If yes, send explanation as 

described in Section V.D.

 State Application Identifier: Enter N/A.

 The application is not subject to review by State Executive Order 12372 Process. 

This is pre-filled as “No, this is not applicable.” 

 If you plan to request a waiver of the volunteer leveraging requirement please select 

“Request a waiver” at the bottom of the screen. A pop-up screen will appear. Select a waiver 

type and enter your volunteer leveraging waiver request justification in the narrative field in 

2,000 characters or less.

 Leave the box for “Program Initiative” blank. 

 The “Estimated Funds Requested” box will be populated automatically after you complete 

the budget.

III. Narratives

The page limitation will be specified in the Notice. The narratives section of the application is 

your 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 funding 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.
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 Don’t make assumptions. Even if you have received funding from CNCS in the 

past, do not assume your reviewers know anything about you, your proposed 

program, your partners, or your beneficiaries. Avoid overuse of acronyms.

 Use an impartial proofreader. Before you submit your application, let someone 

who is completely unfamiliar with your project read and critique the project narrative.

 Follow the instructions and discuss each criterion in the order they are presented 

in the instructions. Use headings to differentiate narrative sections by criterion.

In eGrants, you will enter text for:

 Executive Summary.

 Rationale and Approach (Program Design). 

 Organizational Capability. 

 Cost Effectiveness and Budget Adequacy. 

 Evaluation Plan. 

Note: The Narratives Section also includes fields for Clarification Information, Amendment 

Justification, and Continuation Changes. Please enter N/A in these fields. They will be used at 

a later 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 you 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 of 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.
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B. Selection Criteria

Each application must clearly describe a project that will effectively deploy AmeriCorps 

members to solve a significant community problem. Specifics about the selection criteria are 

published in the Notice.

1. Rationale and Approach/ Program Design (50 percent)

Describe your approach to addressing the need or problem described in the Notice. Reviewers 

will examine the degree to which the applicant demonstrates how AmeriCorps members are 

particularly 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 national 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 more 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 capacity to 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 

your organization has in managing similar programs. Demonstrate compliance with AmeriCorps 

program requirements (for current and former grantees).

Ability to Provide Fiscal Compliance Oversight. Describe the experience and infrastructure 

your 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-Effectiveness 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 maximum cost per MSY, or for existing programs, 

have not increased over previous years unless warranted. 
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 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 total program cost and capacity to raise 

the additional resources beyond the fixed-amount provided by 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 grant, 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 program, 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 

your 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 considered 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-year 

cycle. If your project satisfies the definition of same project, and you have completed one threeyear 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, or completed 

evaluation.

Two projects will be considered the same if they:

 Address the same issue areas.

 Address the same priorities.

 Address the same objectives.

 Serve the same target communities and population.

 Utilize the same sites.

 Use 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. 
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E. Clarification Information

Enter N/A. This field will be used to enter information that requires clarification in the postreview period. Please clearly label new information added during clarification with the date.

F. Continuation Changes

Enter N/A. This field will be used to enter changes in your narratives in your continuation 

requests. 

IV. Performance Measures

Applicants must check the relevant boxes in the Performance Measure tab in eGrants in order to 

be considered for CNCS’ assessment of the strategic considerations and Special Initiatives. 

Grant Characteristics:

 AmeriCorps Member Population – Communities of Color

 AmeriCorps Member Population – Low-income individuals

 AmeriCorps Member Population – Native Americans

 AmeriCorps Member Population – New Americans

 AmeriCorps Member Population – Older Americans

 AmeriCorps Member Population – People with Disabilities

 AmeriCorps Member Population – Rural Residents

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

 AmeriCorps Member Population – Economically disadvantaged young adults/

Opportunity Youth

 AmeriCorps Member Population – None of the above

 Geographic Focus – Rural

 Geographic Focus – Urban

 Encore Program

 Faith- and community-based organizations

 SIG/Priority Schools

All applicants must submit performance measures with their application. See Attachment B for 

instructions for entering performance measures. 

For more information about Performance Measures go to: 

http://www.nationalserviceresources.org/star/ac

For more information about the National Performance Measures go to:

http://www.nationalserviceresources.org/national-performance-measures/home.

V. Documents 

In addition to the application submitted in eGrants, you are required to provide your evaluation, 

labor union concurrence (if necessary – see B., below) a federally-approved indirect cost 

agreement (if 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 eGrants 
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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 copy at the time of application even if you think CNCS may already

have it on file.

B. Labor Union Concurrence

1) If a program applicant: 

a) Proposes to serve as the placement site for AmeriCorps members; and

b) Has employees engaged in the same or substantially similar work as that proposed to 

be carried out by AmeriCorps members; and

c) Those employees are represented by a local labor organization, then the application 

must include the written concurrence of the local labor organization representing 

those employees. Written concurrence can be in the form of a letter or e-mail from the 

local union leadership.

2) If a program applicant:

a) Proposes to place AmeriCorps members at sites where they will be engaged in the 

same or substantially 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 recently 

resigned or discharged employee has recall rights as a result of a collective 

bargaining agreement, from which a recently resigned or discharged employee 

was removed as a result of a reduction in force, or from which a recently

resigned/discharged employee is on leave or strike.

For the purposes of this section, “program applicant” includes any applicant to CNCS or a State 

Commission, as well as any entity applying for assistance or approved national service positions 

through a CNCS grantee or subgrantee.

If 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 applicants 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 Agreement 

submission instructions.
15

D. Delinquent on Federal Debt

Any applicant that checks 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 information 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 alternative 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 security 

measures. Attach a hard copy of the program’s SF424 Facesheet to each document so that we 

know which application corresponds to each document. Documentation submitted without the SF 

424 will not be considered.
16

VI. Budget Instructions 

For Fixed-Amount 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 Regulations

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 year thereafter.

State and National EAP Fixed-amount Grants There are no specific match requirements for fixedamount 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 years, and the increasing minimums in years 

thereafter, are maintained. See 45 CFR §§ 2521.35–2521.90 for the specific regulations.

 If you are applying for the first time, you must match with cash or in-kind contributions at 

least 24% of the project’s total Operating Costs (Section I) plus Member Costs (Section II) 

plus Administrative Costs (Section III). If you are 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. Identify each 

match source separately. Include dollar amount, the match classification (cash, in-kind, or 

Not Available) and the source type (Private, State/Local, Federal, Other or Not Available). 

Define all acronyms the first time they are used. 

 See Attachment H for instructions for applying for the Alternative Match Schedule.

Note: The CNCS legislation 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

Grantees that use federal funds as match will be required to report the sources and amounts on 

the FFR.

B. Preparing Your Budget

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

narrative. Reviewers will consider the information you provide in this section in their assessment 

of the Cost-Effectiveness and Budget Adequacy selection criterion. 

Follow the detailed budget 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 detailed 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 limited 

compliance check to validate the budget. If it finds any compliance issues you will receive a 

warning and/or error messages. You must resolve all errors before you can submit your budget.

As you prepare your budget:

 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 

circulars are online at www.whitehouse.gov/OMB/circulars.

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

 A-87 - Cost Principles for State, Local, and Indian Tribal Governments, 2 CFR 225

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

Programs must comply with all applicable federal 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 type, organizational 

characteristics, and contact information. Appendix I is a worksheet you can use to prepare to 

enter identifying information 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 I and 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 

your program’s expenses in one line entitled Program Costs.

 Section II: Enter all member costs per the Instructions in Attachment C

 Section III: Enter administrative/indirect costs per the Instructions in Attachment C.

VIII. Review, Authorize, and Submit

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

completing the following sections in eGrants:

 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 

designee and must have an active eGrants account to sign these documents electronically. An 

Authorized Representative is the person in your organization authorized to accept and commit 

funds on behalf of the organization. A copy of the governing body’s authorization for this 

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

Be sure to check your entire application to ensure that there are no errors before submitting it. 

eGrants will also generate a list of errors if there are sections that need to be corrected prior to 

submission when you verify the application. If someone else is acting in the role of the 

applicant’s authorized representative, that person must log into his/her eGrants account and 

proceed with Authorize and Submit. After signing off on the Authorization, Assurances, and 

Certifications, his/her name will override any previous signatory that may appear and show on 

the application as the Authorized Representative.

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

any point during application preparation and submission in the eGrants system must have 

their own eGrants account. Individuals may establish an eGrants account by accessing this link: 

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

Create an account.”
19

ATTACHMENT A: Facesheet Instructions 

(eGrants Applicant Info and Application Info Sections)

Modified Standard Form 424 (Rev. 11/02 to conform to eGrants)

This form is required for applications submitted for federal assistance. 

Item #

1. Filled in for your convenience.

2. Self-explanatory.

3. 3. a. and 3. b. are for state use only (if applicable).

4. Item 4. a: Leave blank.

Item 4. b: If you are a recipient in year 2 or 3 of an already-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. Item 7. a.: Enter the appropriate letter in the box.

Item 7. b.: Please enter the characteristic(s) that best describe your organization.

K-12 Education Non-Profit Organizations

1 School (K-12) 11 Community-Based Organization 

2 Local Education Agency 12 Faith-Based Organization

3 State Education Agency 13 Chamber of Commerce/ Business Association

14 Community Action Agency/ Program

Higher Education 15 Service/Civic Organization

4 Vocational/Technical College 16 Volunteer Management Organization

5 Community College 17 Self-Incorporated Senior Corps Project

6 2-year College 18 Statewide Association

7 4-year College 19 National Non-Profit (Multistate) 

8 Hispanic Serving College or University 20 Local Affiliate of National Organization

9 Historically Black College or University 21 Tribal Organization (Non-government) 

10 Tribally Controlled College or University 22 Other Native American Organization

Government

23 Local Government-Municipal 28 Other State Government 

24 Health Department 29 Tribal Government Entity

 25 Law Enforcement Agency 30 Area Agency on Aging

 26 Governor’s Office 31 U.S. Territory 

27 State Commission/Alternative Administrative Entity
20

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 organization 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 instructed 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 twoletter abbreviation with both letters capitalized for each state where you plan to operate. Separate 

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

each one with the two-letter capitalized state abbreviation.

13. (See item 8) “New” application 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 budget period on 

each appropriate line, as shown below. The value of in-kind contributions should be included in 

these amounts, as applicable. For revisions (See item 8), if the action will result in a dollar change 

to an existing 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 amount of the applicant share that is coming from state sources.

d. Local The amount of the applicant share that is coming from local governmental sources 

(e.g., city, county and other municipal sources).

e. Other The amount of the applicant share that is coming from non-governmental sources.

f. Program The amount of the applicant share that is coming from income generated by 
21

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 be 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 OF PERSON TO BE CONTACTED 

ON

MATTERS 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. YES. THIS PREAPPLICATION/APPLICATION WAS MADE 

AVAILABLE

 TO THE STATE EXECUTIVE ORDER 12372 PROCESSS 

FOR

 REVIEW ON:

 DATE ___________________________________

 b. NO. PROGRAM IS NOT COVERED BY E.O. 12372

 

 

a. FEDERAL

$

b. APPLICANT

$

c. STATE

$

d. LOCAL

$

e. OTHER

$

f. PROGRAM 

INCOME $

g. TOTAL

$ 

18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT 

HAS BEEN 

DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE 

ASSISTANCE IS AWARDED. a. TYPED NAME OF AUTHORIZED 

REPRESENTATIVE: 

b. TITLE: c. TELEPHONE NUMBER:

d. SIGNATURE OF AUTHORIZED REPRESENTATIVE: 

e. DATE SIGNED:

 
23

ATTACHMENT 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, objectives, MSYs, and slot allocations for your application, click the 

“Edit Objectives/MSYs/Slots” button. 

After you have created at least one aligned performance measure, the Home Page will display a 

chart summarizing your measures. To edit a performance measure, click the “Edit” button. To 

delete a measure, click “Delete.” To create a new performance measure, click the “Add New 

Performance Measure” button.

Objectives Tab

An expandable list of CNCS focus areas appears on this tab. When you click on a focus area, a 

list of objectives from the CNCS strategic plan appears. A list of common interventions appears 

under each objective. 

First click on a focus area. Then click on an objective and select all interventions that are part of 

your program design. Interventions are the activities that members and volunteers will carry out 

to address the problem(s) identified in the application. Select “other” if one of your program’s 

interventions does not appear on the list. Repeat these actions for each of your program’s focus 
24

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. Only 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 allocation of MSYs and slots across the focus 

areas and objectives you have selected. Begin by 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 percentage

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. It is acceptable for 

slots in this table to exceed total slots requested in the application due to double counting 

members’ service across multiple objectives. 

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 performance 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 objectives tab.

Provide a short, descriptive title for your performance measure.
25

Briefly describe the problem your program will address in this performance measure.

Select the intervention(s) to be delivered by members and member-supported volunteers. The 

list of interventions includes the ones you selected previously for this objective. Select only the 

interventions that will lead to the outcomes of this aligned performance measure. If you selected 

“other” as an intervention and wish to include an applicant-determined intervention in your 

aligned performance measure, click “add user intervention” and enter a one or two word 

description of the intervention.

Select output(s) for your aligned performance measure. The output list includes only the 

National Performance Measure outputs that correspond to the objectives you have selected. If 

you do not wish to select National Performance Measures, you may create an applicantdetermined output by clicking “Add User Output.” 

Select outcome(s). If you have selected 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, create 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 MSYs and slots your program will allocate to achieving the outcomes you 

have selected in this performance measure. Since programs are not required to measure all grant 

activities, the number you enter does not have to correspond to the MSY chart you created on the 

MSY/Slots tab; however, the total number of MSYs across all performance measures within a 

single objective cannot exceed the total number of MSYs previously allocated to that objective. 

Slots may be double-counted across performance measures, but MSYs may not.

Click “next” to proceed to the data collection tab. Later you can return to this tab to create 

additional aligned performance measures.

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 should describe the population you intend to count (children, miles, etc.). Do not 

enter percents or member hours as units of measure.

After entering data collection information for all outputs and outcomes, click “Mark Complete.” 

You will return to the Performance Measure tab. If you wish to create another performance 

measure, repeat the process. If you would like to continue to the next step of the module, click 

“Next.”

Summary Tab

The summary tab shows all of the information you have entered in the 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

ATTACHMENT 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 separately and provide salary and 

percentage of effort as percentage of FTE devoted to this award. Each staff person’s role listed in 

the budget must be described in the application narrative and each staff person mentioned in the 

narrative must be listed in the budget as either CNCS or Grantee share. Because the purpose of 

this grant is to enable and stimulate volunteer community service, do not include the value of 

direct community service performed by volunteers. However, you may include the value of 

volunteer services contributed to the organization for organizational functions such as 

accounting, audit work, or training of staff and AmeriCorps members.

B. Personnel Fringe Benefits

Under “Purpose/Description,” identify the types of fringe benefits to be covered and the costs of 

benefit(s) for each staff position. Allowable fringe benefits typically include FICA, Worker’s 

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

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

benefit as a separate item. If a fringe benefit amount is over 30%, please list covered items 

separately and justify the high cost. Holidays, leave, and other similar vacation benefits are not 

included in the fringe benefit rates, but are absorbed into the personnel expenses (salary) budget 

line item. 

C. 1. Staff Travel

Describe the purpose for which program staff will 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, daily per diem, and similar supporting 

information. Reimbursement should not exceed the federal mileage rate unless a result of 

applicant policy and justified in the budget narrative. Only domestic travel is allowable.

We expect 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-expendable personal property having a useful life of more 

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

attachments, and modifications). Any items that do not meet this definition should be entered in 

E. Supplies below. 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, grantees may only 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 using the AmeriCorps logo in the budget description. All 

safety 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 Services

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

consultants, who will be listed in Sections G. and H., below. 

G. 1. Staff Training

Include the costs associated with training staff on project requirements and training to enhance 

the skills staff need for effective project implementation, i.e., project or financial management, 

team building, etc. If using a consultant(s) for training, indicate the estimated daily rate. 

G. 2. Member Training

Include the costs associated with member training to support them in carrying out their service 

activities. You may also use this section to request funds to support training in Life after 

AmeriCorps. If using a consultant(s) for training, indicate the estimated daily rate, not to exceed 

the daily rate limit. 

H. Evaluation

Include costs for project evaluation activities, including additional staff time or subcontracts, use 

of evaluation consultants, purchase of instrumentation, and other costs specifically for this 

activity not budgeted in Personnel Expenses. This cost does not include the daily/weekly 

gathering of data to assess progress toward meeting performance measures, but is a larger 
29

assessment of the impact your project is having on the community, as well as an assessment of 

the overall systems and project design. Indicate daily rates of consultants, where applicable.

I. Other Program Operating Costs

Allowable costs in this budget category should include when applicable:

 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 

payment from the grant (federal or non-federal share).

 Office space rental for projects operating without an approved indirect cost rate agreement 

that covers office space. If space is budgeted and it is shared with other projects or activities, 

the costs must be equitably pro-rated and allocated between the activities or projects.

 Utilities, telephone, internet and similar expenses that are specifically used for AmeriCorps 

members and AmeriCorps project staff, and are not part of the organization’s indirect cost

allocation pool. If such expenses are budgeted and shared with other projects or activities, the 

costs must be equitably pro-rated and allocated between the activities or projects.

 Recognition costs for members. List each item and provide a justification in the budget 

narrative. Gifts and/or food in an entertainment/event setting are not allowable costs. 

 Multi-state applicants: Indicate the number of subgrants and the average amount of 

subgrants. Indicate any match that you will require of your subgrants under the “grantee 

share” column in this category. Subgranted funds may only 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 portions between the CNCS share 

(CNCS Share) and grantee match (Grantee Share). 

The minimum and maximum living allowance amounts are provided in the Notice.

In eGrants, enter the total number of members you are requesting in each category. Enter the 

average amount of the living allowance for each type of member. In addition, enter the number 

of members for which you are not requesting funds for a living allowance, but for which you are 

requesting education awards. 

B. Member Support Costs

Consistent with the laws of the states where your members serve, you must provide members 

with the benefits described below. 

 FICA. Unless exempted by the IRS, all projects must pay FICA for any member receiving a 

living allowance, even when CNCS does not supply the living allowance. If exempted, please 
30

note in the narrative. In the first column next to FICA, indicate the number of members who 

will receive FICA. Calculate the FICA at 7.65% of the total amount of the living allowance. 

 Worker’s Compensation. Some states require worker’s compensation for AmeriCorps 

members. You must check with State Departments of Labor or State Commissions where 

members serve to determine if you are required to pay worker’s compensation and at what 

level. If you are not required to pay worker’s compensation, 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 AmeriCorps requirements. Except as stated below, you may not pay health 

care benefits to less-than-full-time members with CNCS funds. You may choose to provide 

health care benefits to less-than-full-time members from other sources (i.e., non-federal) but 

the cost cannot be included in the budget. Less-than-full-time members who are serving in a 

full-time capacity for a sustained period of time (such as a full-time summer project) are 

eligible for health care benefits. In your budget narrative, indicate the number of members 

who will receive health care benefits. CNCS will not pay for dependent coverage. 

 Unemployment Insurance and Other Member Support Costs. Include any other required 

member support costs here. Some states require unemployment coverage for their 

AmeriCorps members. You may not charge the cost of unemployment insurance taxes to the 

grant unless mandated by state law. Programs are responsible for determining the 

requirements of state law by consulting State Commissions, legal counsel, or the applicable 

state agencies.

Section III. Administrative/Indirect Costs 

Definitions 

Administrative costs are general or centralized expenses of the 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, administrative costs mean those costs that are included in the 

organization’s indirect cost rate agreement. Such costs are generally identified with the 

organization’s overall operation and are further described in Office of Management and Budget 

Circulars A-21, A-87, and A-122. 

Options for Calculating Administrative/Indirect Costs (choose either A OR B)

Applicants choose one of two methods to calculate allowable administrative costs – a CNCSfixed percentage rate method or a federally approved indirect cost rate method. Regardless of the 

option chosen, the CNCS share of administrative costs is limited to 5% of the total CNCS funds 

actually expended under this grant. Do not create additional lines in this category.

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 documentation supporting the 

allocation. If you choose the CNCS-fixed percentage rate method (Section IIIA in eGrants), you 
31

may charge, for administrative costs, a fixed 5% of the total of the CNCS funds expended. In 

order to charge this fixed 5%, the grantee match for administrative costs may not exceed 10% of 

all direct cost expenditures. 

1. To determine the maximum CNCS share for Section III: Multiply the sum of the CNCS

funding shares of Sections I and II by 0.0526. This is the maximum amount you can request 

as 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 yet established. Enter this amount as the CNCS share for Section III A. 

2. To determine the Grantee share for Section III: Multiply the total (both CNCS and grantee 

share) of Sections I and II by 10% (0.10) and enter this amount as the grantee share for 

Section III A.

3. Enter the sum of the CNCS and grantee shares 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 by CNCS. 

Specify the Cost Type for which your organization has current documentation on file, i.e., 

Provisional, Predetermined, Fixed, or Final indirect cost rate. Supply your approved IDC rate 

(percentage) and the base upon which this rate is calculated (direct salaries, salaries and fringe 

benefits, etc.). It is at your discretion whether or not to claim your entire IDC rate to calculate 

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

Claimed field. 

1. Determine the base amount of direct costs to which you will apply the IDC rate, including 

both the CNCS and Grantee shares, as prescribed by your established rate agreement (i.e., based 

on salaries and benefits, total direct costs, or other). Then multiply the appropriate direct costs by

the rate being claimed. This will determine the total amount of indirect costs allowable under the 

grant. 
32

2. To determine the CNCS share: Multiply the sum of the CNCS funding share in Sections I and 

II by 0.0526. This is the maximum amount you can claim as the CNCS share of indirect costs.

If a Commission elects to retain a share of the 5% of federal funds available, please note the 

percentage or amount in the 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 CNCS

administrative share) from the amount calculated in step a (the Indirect Cost total). This is the 

amount the applicant can claim as grantee share for administrative costs.

Source of Match

In the “Source of Match” field that appears at the end of Budget Section III, enter a 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 acronyms the first time they are used.
33

ATTACHMENT 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

Totals
34

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-kind $ $ $ .

Cash $ $ $

Total $ $ $
37

ATTACHMENT 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 only request a fixed amount of funding per MSY. Therefore, 

Fixed-amount applicants are not required to complete a detailed budget. In addition, the 

matching requirements in 45 CFR §§ 2521.40– 2521.95 do not apply to EAP and other Fixedamount grant applicants. 

Budget Section II. AmeriCorps Member Positions

Member Positions

Identify the number of members you are requesting by category (i.e. full-time, half-time, reduced 

half-time, quarter-time, minimum-time) and list under the column labeled #w/o Allow (without 

CNCS-funded living allowance.) Leave all other columns blank.

The total number of member service years (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,” you will enter the calculation for your grant request. Applicants may 

request up to $800 per member service year (MSY).

Display your calculation in the following format:

Member 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

ATTACHMENT F: Budget Worksheet for Fixed-Amount Grants 

(eGrants Budget Section)

Complete the fields for the # w/o Allowance only.

Member Positions

Item # 

Mbrs

Allowance 

Rate

# w/o 

Allow

Total 

Amount

CNCS 

Share

Grantee 

Share

Full Time (1700 hrs)

1-Year Half Time (900 

hrs)

2-Year Half Time (1st

Year)

2-Year Half Time (2nd

Year) 

Reduced Half Time

(675 hrs)

Quarter Time (450 hrs)

Minimum Time (300 hrs)

Subtotal MSY Cost/MSY

Purpose Calculation Total 

Amount

CNCS Share Grantee 

Share

Program Grant 

Request

Subtotal
39

ATTACHMENT 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 funds must 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 percentage of the salaries to which they apply or list each benefit as a separate item. If the 

fringe amount is over 30%, please list separately. 

Yes __ No __ Holidays, leave, and other similar vacation benefits are not included in the fringe benefit rates but 

are absorbed into the personnel expenses (salary) budget 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 not include general use office equipment) are limited to 

10% of the total grant amount?

Yes __ No __ All single equipment items over $5000 per unit are specifically listed?

Yes __ No __ Justification/explanation of equipment items is included in the budget narrative?

Yes __ No __ All single supply items over $1000 per unit are specifically listed?

Yes __ No __

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 proposed?

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. Member 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 lower 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 maximum 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 not based on the specified number of hours served.

Yes __ No __ Is FICA calculated correctly? You must pay FICA for any member receiving a living allowance. 

Unless exempted by the IRS, calculate FICA at 7.65% of the total amount of the living allowance. 

Yes __ No __

Is the Worker’s Compensation calculation correct? Some states require worker’s compensation for 

AmeriCorps members. Check with your local State Department of Labor or State Commission to 

determine whether or not you are required to pay worker’s compensation and at what level (i.e., 

rate). If you are not required to pay worker’s compensation, you need to provide similar coverage 

for members’ on-the-job injuries through their own existing coverage or a new policy purchased in 

accordance with normal 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 fulltime capacity)? If your project chooses to provide health care to other half-time members, 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 participation in the project. In addition, projects must 

provide coverage if a full-time member 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 the 

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) costs for financial, accounting, audit, 

internal evaluations, and contracting functions; (3) costs for insurance that protects the entity that 

operates the project; and (4) the portion of the salaries and benefits of the director and any other 

project administrative staff not attributable to the time spent in direct support of a specific project.

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 which the rate is applied has been specified?

In Compliance? Match

Yes __ No __ Is the overall match being met at the required level, based on the year of funding?

Yes __ No __

For all matching funds, the source(s) [private, state and local, and federal], the type of contribution 

(cash or in-kind), and the amount (or an estimate) of match, are clearly identified in the narrative 

and in the Source of Match field in eGrants? 
41

ATTACHMENT H: Alternative Match Instructions

Grantees are required to meet an overall matching rate that increases over time. You have the 

flexibility to meet the overall match requirements in any of the three budget areas, as long as the 

minimum match of 24% for the first three years, and the increasing minimums in years 

thereafter, are maintained. See 45 CFR §§ 2521.35–2521.90 for the specific regulations.

Special Circumstances for an 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 

demonstrate that your program is either located in a rural county or in a severely economically 

distressed community as defined below.

A. Rural County: In determining whether a program is rural, CNCS will consider the most 

recent Beale code rating published by the U.S. Department of Agriculture for the county in 

which the program is located. Any program located in a county with a Beale code of 6, 7, 8 or 9 

is eligible to apply for the alternative match requirement. See Attachment J for the Table of 

Beale codes.

B. Severely Economically Distressed County: In determining whether a program is located in 

a severely economically distressed county, CNCS will consider the following list of countylevel characteristics. See Attachment J for a list of website addresses where this publicly

available information can be found.

 The county-level per capita income is less than or equal to 75 percent of the national 

average for all counties using the most recent census data or Bureau of Economic 

Analysis data;

 The county-level poverty rate is equal to or greater than 125 percent of the national 

average for all counties using the most recent census data; and

 The county-level unemployment is above the national average for all counties for the 

previous 12 months using the most recently available Bureau of Labor Statistics data. 

 The areas served by the program lack basic infrastructure such as water or electricity. 

C. Program Location: Except when approved otherwise, CNCS will determine the location of 

your program based on the legal applicant’s address. If you believe that the legal applicant’s 

address is not the appropriate way to consider the location of your program, you must provide 

relevant facts about your program location in your request. CNCS will, in its sole discretion, 

determine whether some other address is more appropriate for determining a program’s location.

If your program is located in one of these areas, see the instructions below for applying for this

alternative match schedule. You must submit your requestfor 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 your budget into eGrants under the Alternative 

Match Schedule. The alternative match requirement will be in effect for the upcoming threeyear grant cycle.
42

D. Instructions for the Alternative Match Schedule

Submit e-mail applications by the application deadline of XX to:

 Single-state 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. Identify the basis for your request as either a rural county or a severely economically

distressed community as described above. 

b. Describe where your program operates 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 county per-capita income, poverty, and unemployment levels. 

f. Demonstrate that your county per-capita income, poverty, and unemployment levels 

are above or below the national averages. Identify the data source(s) used to make 

your determination. 

g. Provide any other statistics you deem relevant to demonstrate your county is 

economically 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 justification for requesting an alternative location(s).

5. Other: Provide any other justification and information for your request that is not presented 

in the responses to the above.
43

APPENDIX 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 Type* 

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 B
44

ATTACHMENT J: Beale Codes and County-Level Economic Data

Rural Community

Beale codes are published by the U.S. Department of Agriculture and are used to classify

counties as being more urban or more rural. Counties are designated on a scale from one to nine 

according to the following descriptions:

2003 Beale Codes

Code# 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 publicly available information on 

county-level economic data including per capita income, poverty rate, and unemployment levels 

can be found.

WEBSITE ADDRESS EXPLANATION

www.econdata.net Econdata.Net: This site Links to a variety 

of social and economic data by states, 

counties and metro areas.

http://www.bea.gov/regional/ Bureau of 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 poverty and 

population estimates by county for all 

states except Puerto Rico.

www.census.gov/main/www/cen2000.html Census Bureau’s American Fact-finder: 

Provides all 1990 and 2000 census data 

including estimates on poverty, per capita 

income and unemployment by counties, 

states, and metro areas including Puerto 

Rico.

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 RuralUrban Continuum Codes (Beale codes): 

Provides urban rural code for all counties 

in US.

www.census.gov/hhes/www/saipe/index.html Census Bureau’s Small Area Poverty 

Estimates: Provides data on poverty and 

population estimates by county for all 

states except Puerto Rico.
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 RuralUrban Continuum Codes (Beale codes): 

Provides urban rural code for all 

counties in US. 
47

ATTACHMENT K: Assurances and Certifications 

(eGrants Review, Authorize 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. You 

must submit an explanation of why you cannot do so. We will consider your explanation in determining whether to enter 

into this transaction. However, your failure to furnish an explanation will disqualify your application.

b) Erroneous certification or assurance

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

into this transaction. If we 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.

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 “prospective primary participant in a covered transaction” as defined in the rules implementing 

Executive Order 12549. You may contact us for assistance in obtaining a copy of those regulations.

e) Assurance requirement for subgrant agreements

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

covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation

in this covered transaction, unless authorized by us.

f) Assurance inclusion in subgrant agreements

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

covered transactions and in all solicitations for lower tier covered transactions that the participants are not debarred, 

suspended, ineligible, or voluntarily excluded from the covered transaction.

g) Assurance of subgrant principals

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

suspended, ineligible, or voluntarily excluded from the covered transaction, unless you know that the assurance is erroneous.

You may decide the method and frequency by which you determine the eligibility of your principals. You may, but are not 

required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.

h) Non-assurance in subgrant agreements

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

voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, 

we may terminate this transaction for cause or default. 

i) Prudent person standard

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

in good faith the assurances and certifications required. Your knowledge and information is not required to exceed that 

which is normally possessed by a prudent person in the ordinary course of business dealings.
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.

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

authorized representative, access to and the right to examine all records, books, papers, or documents related to the 

award; and will establish a proper accounting system in accordance with generally accepted accounting standards or 

agency directives.

 Will establish safeguards to prohibit employees from using their position for a purpose that constitutes or presents the 

appearance of personal or organizational conflict of interest, or personal gain.

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

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

for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of 

OPM’s Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).

 Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: Title VI of the 

Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color, or national origin; (b) 

Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686). which prohibits 

discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), 

which prohibits discrimination on the basis of disability (d) The Age Discrimination Act of 1975, as amended (42 

U.S.C. 6101-6107), which prohibits discrimination on the basis of age; (e) The Drug Abuse Office and Treatment Act 

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

Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, 

relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health 

Service Act of 1912 (42 U.S.C. 290dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug 

abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to 

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

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

which may apply to the application.

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

and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of 

persons displaced or whose property is acquired as a result of federal or federally assisted programs. These 

requirements apply to all interests in real property acquired for project purposes regardless of federal participation in 

purchases.

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

activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

 Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C 276a and 276a-77), the Copeland 

Act (40 U.S.C 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), 

regarding labor standards for Federally assisted construction sub-agreements.

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

Protection Act of 1973 (P.L. 93-234) which requires the recipients in a special flood hazard area to participate in the 

program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

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

environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and 

Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands 

pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of 

project consistency with the approved state management program developed under the Coastal Zone Management Act 

of 1972 (16 U.S.C 1451 et seq.); (f) conformity of federal actions to State (Clean Air) Implementation Plans under 

Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground 
49

sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and (h) protection of 

endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205).

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

potential components of the national wild and scenic rivers system.

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

1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the 

Archaeological and Historic Preservation Act of 1974 (16U.S.C. 469a-l et seq.).

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

related activities supported by this award of assistance.

 Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) 

pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities 

supported by this award of assistance.

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

of lead based paint in construction or rehabilitation of residence structures.

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

1984, as amended, and OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations.

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

guidelines, and policies governing this program.

 Will comply with 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 assistance under the national service laws shall not 

discriminate against a participant in, or member of the staff of, such project or program on the basis of race, color, 

national origin, sex, age, political affiliation, disability, or on the basis of religion. (NOTE: the prohibition on religious 

discrimination does not apply to the employment of any staff member paid with non-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.usdoj.gov/archive/fbci/effect-rfra.pdf.

 Will comply with all other federal statutes relating to nondiscrimination, including any self-evaluation requirements. 

These include but are not limited to: (a)Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits 

discrimination on the basis of race, color, or national origin; (b) Title IX of the Education Amendments of 1972, as 

amended (20 U.S.C. 1681-1683, and 1685-1686). which prohibits discrimination on the basis of sex; (c) Section 504 of 

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

(d) The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the 

basis of age; (e) The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to 

nondiscrimination on the basis of drug abuse; (f) The Comprehensive 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) Title VIII of the 

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

financing of housing; 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 participants 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 program; 
50

 Will, prior to the placement of participants, consult with the appropriate local labor organization, if any, representing 

employees in the area who are engaged in the same or similar work as that proposed to be carried out by an 

AmeriCorps program, to ensure compliance with the nondisplacement requirements specified in section 177 of the 

NCSA; 

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

of children in developing and operating the program;

 Will, before transporting minor children, provide the children’s parents or legal guardians with the reason for the 

transportation and obtain the parent’s or legal guardian’s permission for such transportation, consistent with state law; 

 Will, in the case of an AmeriCorps program that is not funded through a State, consult with and coordinate activities 

with the State Commission for the state in which the program operates.

 Will ensure that any national service program carried out by the applicant using assistance provided under section 121 

of the National and Community Service Act of 1990 and any national service program supported by a grant made by 

the applicant using such assistance will address unmet human, educational, environmental, or public safety needs 

through services that provide a direct benefit to the community in which the service is performed; 

 Will comply with the nonduplication and nondisplacement requirements set out in section 177 of the National and 

Community Service Act of 1990, and in 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 

employment, and, if appropriate, opportunities for participants to reflect on their service experiences; 

 Will arrange for an independent evaluation of any national service program carried out using assistance provided to the 

applicant under section 121 of the National and Community Service Act of 1990 or, with the approval of the CNCS, 

conduct an internal evaluation of the program; 

 Will apply 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 areas 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 used to support national service programs selected by the 

State on a competitive basis;

 If a state applicant, will seek to ensure an equitable allocation within the State of assistance and approved national 

service positions, taking into consideration such factors as the locations of the programs, population density, and 

economic distress;

 If a state applicant, will ensure that not less than 60% of the assistance will be used to make grants to support national 

service programs other than those carried out by a State 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 agency? 

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that neither the 

applicant nor its principals: 

 Is presently excluded or disqualified; 

 Has been convicted within the preceding three years of any of the offenses listed in § 180.800(a) or had a civil 

judgment rendered against it for one of those offenses within that time period; 

 Is presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) 

with commission or any of the offenses listed in § 180.800(a); or

 Has had one or more public transactions (Federal, State, or local) terminated within the preceding three years for cause 

or default. 

Certification – Drug Free Workplace

This certification 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 basis, to maintain a drug-free workplace. The certification set out below is a 

material representation of fact upon which reliance will be placed when the agency determines to award the grant. False 

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

government-wide suspension or debarment (see 45 CFR Part 2542, Subparts G and H). 

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

provide a drug-free workplace by: 

A. Publishing a drug-free workplace statement that:

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

substance is prohibited in the grantee’s workplace;

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

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

terms of the statement and notify the grantee in writing if the employee is convicted for a violation of a 

criminal drug statute occurring in the workplace within five days of the conviction; 

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

the performance of any Federal award; 

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

a. The dangers of drug abuse in the workplace;

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

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

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

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

notification within 10 calendar days of learning that an employee has been convicted of a drug violation in the 

workplace; 

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

violation in the workplace: 

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

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

approved for these purposes by a Federal, State, or local health, law enforcement, or other appropriate 

agency; 
52

F. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (A) 

through (E). 

Certification - Lobbying Activities

As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of the applicant, I certify, to the best 

of my knowledge and belief, that:

 No federal appropriated funds have been paid or will be paid, by or on behalf of the applicant, to any person for 

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

Congress in connection with the awarding of any federal contract, the making of any federal loan, the entering into 

of any cooperative agreement, or modification of any federal contract, grant, loan, or cooperative agreement;

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

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

Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or 

cooperative agreement, the applicant will submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in 

accordance with its instructions;

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

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

agreements) and that all subrecipients will certify and disclose accordingly. 

Erroneous certification or assurance

The assurances and certifications are material representations of fact upon which we rely in determining whether to enter into this 

transaction. If we later determine that you knowingly submitted an erroneous certification or assurance, in addition to other 

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

Notice of error in certification or assurance

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

submitted or has become erroneous because of changed circumstances.

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 voluntarily excluded from participation in 

this covered transaction, unless authorized by us.

Assurance inclusion in subgrant agreements

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

transactions and in all solicitations for lower tier covered transactions that the participants are not debarred, suspended, ineligible, 

or voluntarily excluded from the covered transaction.

Assurance of subgrant principals

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

ineligible, or voluntarily excluded from the covered transaction, unless you know that the assurance is erroneous. You may 

decide the method and frequency by which you determine the eligibility of your principals. You may, but are not required to, 

check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.

Non-assurance in subgrant agreements

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

excluded from participation in this transaction, in addition to other remedies available to the federal government, we may 

terminate this transaction for cause or default. 

Prudent person standard

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

good faith the assurances and certifications required. Your knowledge and information is not required to exceed that which is 

normally possessed by a prudent person in the ordinary course of business dealings.
53

Certification - Grant Review Process (State Commissions Only)

I certify that in conducting our review process, we have ensured compliance with the National and Community Service Act of 

1990, CNCS peer review requirements, and all state laws and conflict of interest rules.

ASSURANCES AND CERTIFICATIONS

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 SIGNATURE: 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 Representative: 

Signature: 

Date: 
54

ATTACHMENT L: Beneficiary Populations/Grant Characteristics

 AmeriCorps Member Population – Communities of Color

 AmeriCorps Member Population – Low-income individuals

 AmeriCorps Member Population – Native Americans

 AmeriCorps Member Population – New Americans

 AmeriCorps Member Population – Older Americans

 AmeriCorps Member Population – People with Disabilities

 AmeriCorps Member Population – Rural Residents

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

 AmeriCorps Member Population – Economically disadvantaged young 

adults/Opportunity Youth

 AmeriCorps Member Population – None of the above

 Geographic Focus – Rural

 Geographic Focus – Urban

 Encore Program

 Faith- and community-based organizations

 SIG/Priority Schools