[Federal Register Volume 62, Number 55 (Friday, March 21, 1997)]
[Notices]
[Pages 13623-13645]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-7213]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
[Program Announcement No. OCS 97-08]


Request for Applications Under the Office of Community Services' 
Fiscal Year 1997 Community Food and Nutrition Program

AGENCY: Office of Community Services, ACF, DHHS.

ACTION: Request for applications under the Office of Community 
Services' Community Food and Nutrition Program.

-----------------------------------------------------------------------

SUMMARY: The Office of Community Services (OCS) announces that 
competing applications will be accepted for new grants pursuant to the 
Secretary's discretionary authority under Section 681A of the Community 
Services Block Grant Act of 1981, as amended. This Program Announcement 
contains forms and instructions for submitting an application. The 
awarding of grants under this Program Announcement is subject to the 
availability of funds for support of these activities.

    CLOSING DATE AND TIME: The closing date and time for receipt of 
applications is May 20, 1997 at 4:30 p.m., eastern time zone. 
Applications received after

[[Page 13624]]

4:30 p.m. on that day will be classified as late.
    Deadline: Mailed applications shall be considered as meeting an 
announced deadline if they are received on or before the deadline date 
and time at the U.S. Department of Health and Human Services, 
Administration for Children and Families, Division of Discretionary 
Grants, 370 L'Enfant Promenade, S.W., Mail Stop 6C-462, Washington, 
D.C. 20447, Attention: Application for Community Food and Nutrition 
Program. Applicants are responsible for mailing applications well in 
advance, when using all mail services, to ensure that the applications 
are received on or before the deadline date and time.
    Applications handcarried by applicants, applicant couriers, or by 
overnight/express mail couriers shall be considered as meeting an 
announced deadline if they are received on or before the deadline date, 
between the hours of 8:00 a.m. and 4:30 p.m., at the U.S. Department of 
Health and Human Services, Administration for Children and Families, 
Division of Discretionary Grants, ACF Mailroom, 2nd Floor Loading Dock, 
Aerospace Center, 901 D Street, S.W., Washington, D.C. 20024, between 
Monday and Friday (excluding Federal holidays). (Applicants are 
cautioned that express/overnight mail services do not always deliver as 
agreed.)
    ACF cannot accommodate transmission of applications by fax or 
through other electronic media. Therefore, applications transmitted to 
ACF electronically will not be accepted regardless of date or time of 
submission and time of receipt.
    Late applications: Applications which do not meet the criteria 
above are considered late applications. ACF shall notify each late 
applicant that its application will not be considered in the current 
competition.
    Extension of deadlines: ACF may extend the deadline for all 
applicants because of acts of God such as floods, hurricanes, etc., or 
when there is widespread disruption of the mails. However, if ACF does 
not extend the deadline for all applicants, it may not waive or extend 
the deadline for any applicants.

FOR FURTHER INFORMATION CONTACT: Joseph Carroll, Acting Director, 
Administration for Children and Families, Office of Community Services, 
370 L'Enfant Promenade, S.W., Washington, DC 20447, (202) 401-9345, fax 
(202) 401-4687.

Table of Contents

Part A--Preamble
    1. Legislative Authority
    2. Definitions of Terms
    3. Purpose of Community Food and Nutrition Program
    4. Project Requirements
Part B--Application Requirements
    1. Eligible applicants
    2. Availability of Funds and Grant Amounts
    3. Project Periods and Budget Periods
    4. Administrative Costs/Indirect Costs
    5. Program Beneficiaries
    6. Number of Projects in Application
    7. Multiple Submittal
    8. Sub-Contracting or Delegating Projects
Part C--Program Area
    General Projects
Part D--Review Criteria
    Criteria for Review and Evaluation of Applications Submitted 
Under this Program Announcement
Part E--Instructions for Completing Application Package
    1. SF-424--Application for Federal Assistance
    2. SF-424A--Budget Information--Non-Construction Programs
    3. SF-424B--Assurances--Non-Construction Programs
    4. Project Narrative
Part F--Application Procedures
    l. Availability of Forms
    2. Application Submission
    3. Intergovernmental Review
    4. Application Consideration
    5. Criteria for Screening Applications
Part G--Contents of Application Package and Receipt Process
Part H--Post Award Information and Reporting Requirements

Part A--Preamble

1. Legislative Authority

    The Community Services Block Grant Act, as amended, authorizes the 
Secretary of Health and Human Services to make funds available under 
several programs to support program activities which will result in 
direct benefits targeted to low-income people. This Program 
Announcement covers the grant authority found at Section 681A, 
Community Food and Nutrition, which authorizes the Secretary to make 
funds available for grants to be awarded on a competitive basis to 
eligible entities for local and statewide programs (1) to coordinate 
existing private and public food assistance resources, whenever such 
coordination is determined to be inadequate, to better serve low-income 
communities; (2) to assist low-income communities to identify potential 
sponsors of child nutrition programs and to initiate new programs in 
underserved or unserved areas; and (3) to develop innovative approaches 
at the State and local levels to meet the nutrition needs of low-income 
people.

2. Definitions of Terms

    For purposes of this Program Announcement the following definitions 
apply:

--Budget Period: The term ``budget period'' refers to the interval of 
time into which a grant period of assistance (project period) is 
divided for budgetary and funding purposes.
--Displaced worker: An individual who is in the labor market but has 
been unemployed for six months or longer.
--Eligible Entity: States and other public and private non-profit 
agencies/organizations including Community Action Agencies. (See Part 
B-1)
--Indian tribe: A tribe, band, or other organized group of Native 
American Indians recognized in the State or States in which it resides 
or considered by the Secretary of the Interior to be an Indian tribe or 
an Indian organization for any purpose.
--Innovative project: One that departs from or significantly modifies 
past program practices and tests a new approach.
--Migrant Farmworker: An individual who works in agricultural 
employment of a seasonal or other temporary nature who is required to 
be absent from his/her place of permanent residence in order to secure 
such employment.
--Project Period: The term ``project period'' refers to the total time 
for which a project is approved for support, including any approved 
extensions.
--Seasonal farmworker: Any individual employed in agricultural work of 
a seasonal or other temporary nature who is able to remain at his/her 
place of permanent residence while employed.
--Self-Sufficiency: A condition where an individual or family does not 
need and is not eligible for public assistance.
--Underserved area (as it pertains to child nutrition programs): A 
locality in which less than one-half of the low-income children 
eligible for assistance participate in any child nutrition program.

3. Purpose of Community Food and Nutrition Program

    The Department of Health and Human Services (DHHS) is committed to 
improving the overall health and nutritional well-being of individuals 
through improved preventive health care and promotion of personal 
responsibility. The DHHS encourages the approach to health promotion 
and nutritional responsibility with personal messages aimed at families 
and

[[Page 13625]]

communities, in various settings and environments in which individuals 
and groups can most effectively be reached.
    The DHHS is specifically interested in improving the health and 
nutrition status of low-income persons through improved access to 
healthy nutritious foods or by other means. DHHS encourages community 
efforts to improve the coordination and integration of health and 
social services for all low-income families, and to identify 
opportunities for collaborating with other programs and services for 
this population. Such collaboration can increase a community's capacity 
to leverage resources and promote an integrated approach to health and 
nutrition through existing programs and services.

4. Project Requirements

    Projects funded under this program should:
    (a) Be designed and intended to provide nutrition benefits, 
including those which incorporate the benefits of disease prevention, 
to a targeted low-income group of people;
    (b) Provide outreach and public education to inform eligible low-
income individuals and families of other nutritional services available 
to them under the various Federally assisted programs;
    (c) Carry out targeted communications/social marketing to improve 
dietary behavior and increase program participation among eligible low-
income populations. Populations to be targeted can include displaced 
workers, elderly people, children, and the working poor.
    (d) Consult with and/or inform local offices that administer other 
food programs such as W.I.C. and Food Stamps, where applicable, to 
ensure effective coordination which can jointly target services to 
increase their effectiveness. Such consultation may include involving 
these offices in the planning of grant applications.
    (e) Focus on one or more legislatively mandated program activities: 
(1) Coordination of existing private and public food assistance 
resources, whenever such coordination is determined to be inadequate, 
to better serve low-income populations; (2) assistance to low-income 
communities in identifying potential sponsors of child nutrition 
programs and initiating new programs in unserved or underserved areas; 
and (3) development of innovative approaches at the state or local 
levels to meet the nutrition needs of low-income people.
    OCS views this program as a capacity building program, rather than 
as a service delivery program.

Part B--Application Requirements

1. Eligible Applicants

    Eligible applicants are States and public and private non-profit 
agencies/organizations with a demonstrated ability to successfully 
develop and implement programs and activities similar to those 
enumerated above. OCS encourages Historically Black Colleges and 
Universities and minority institutions to submit applications. Eligible 
applicants with programs benefitting Native Americans and Migrant 
Farmworkers are also encouraged to submit applications.
    Any non-profit organization submitting an application must submit 
proof of its non-profit status in its application at the time of 
submission. The non-profit agency can accomplish this by providing a 
copy of the applicant's listing in the Internal Revenue Services's 
(IRS) most recent list of tax-exempt organizations described in Section 
501(c)(3) of the IRS tax code or by providing a copy of the currently 
valid IRS tax exemption certificate or by providing a copy of the 
applicant's Articles of Incorporation bearing the seal of the State in 
which the corporation or association is domiciled.

2. Availability of Funds and Grant Amounts

a. Fiscal Year 1997 Funding
    The funds expected to be available for grant awards under the CFN 
Program in fiscal year 1997 are $1,600,000 for General Projects.
b. Grant Amounts
    No individual grant application will be considered for an amount 
which is in excess of $50,000.
c. Mobilization of Resources
    OCS would like to mobilize as many resources as possible to enhance 
projects funded under this program. OCS supports and encourages 
applications submitted by applicants whose programs will leverage other 
resources, either cash or third-party in-kind.

3. Project Periods and Budget Periods

    For most projects OCS will grant funds for one year. However, in 
rare instances, depending on the characteristics of any individual 
project and on the justification presented by the applicant in its 
application, a grant may be made for a period of up to 17 months.

4. Administrative Costs/Indirect Costs

    There is no administrative cost limitation for projects funded 
under this program. Indirect costs consistent with approved Indirect 
Cost Rate Agreements are allowable. Applicants should enclose a copy of 
the current approved rate agreement. However, it should be understood 
that indirect costs are part of, and not in addition to, the amount of 
funds awarded in the subject grant.

5. Program Beneficiaries

    Projects proposed for funding under this Announcement must result 
in direct benefits targeted toward low-income people as defined in the 
most recent Annual Update of Poverty Income Guidelines published by 
DHHS. Attachment A to this Announcement is an excerpt from the most 
recently published guidelines. Annual revisions of these guidelines are 
normally published in the Federal Register in February or early March 
of each year and are applicable to projects being implemented at the 
time of publication. Grantees will be required to apply the most recent 
guidelines throughout the project period. The Federal Register may be 
obtained from public libraries, Congressional offices, or by writing 
the Superintendent of Documents, U.S. Government Printing Office, 
Washington, D.C. 20402. The Federal Register is also available on the 
Internet through GPO Access at the following web address: <a href="http://
www.access.gpo.gov/su__docs/aces/aces140.html">http://
www.access.gpo.gov/su__docs/aces/aces140.html</a>
    No other government agency or privately defined poverty guidelines 
are applicable to the determination of low-income eligibility for this 
OCS program.

6. Number of Projects in Application

    An application may contain only one project and this project must 
address the basic criteria found in Parts C and D. Applications which 
are not in compliance with these requirements will be ineligible for 
funding.

7. Multiple Submittal

    There is no limit to the number of applications that can be 
submitted as long as each application is for a different project. 
However, no applicant can receive more than one grant.

8. Sub-Contracting or Delegating Projects

    OCS will not fund any project where the role of the eligible 
applicant is primarily to serve as a conduit for funds to other 
organizations.

[[Page 13626]]

Part C--Program Area

General Projects

    The application should include a description of the target area and 
population to be served as well as a discussion of the nature and 
extent of the problem to be solved. The application must contain a 
detailed and specific work program that is both sound and feasible. 
Projects funded under this Announcement must produce permanent and 
measurable results that fulfill the purposes of this program as 
described above. The OCS grant funds, in combination with private and/
or other public resources, must be targeted to low-income individuals 
and communities.
    Applicants will certify in their submission that projects will only 
serve the low-income population as stipulated in the DHHS Poverty 
Income Guidelines (Attachment A). Failure to comply with the income 
guidelines may result in the application being ineligible for 
consideration for funding.
    If an applicant is proposing a project which will affect a property 
listed in or eligible for inclusion in the National Register of 
Historic Places, it must identify this property in the narrative and 
explain how it has complied with the provisions of Section 106 of the 
National Historic Preservation Act of 1966 as amended. If there is any 
question as to whether the property is listed in or eligible for 
inclusion in the National Register of Historic Places, applicant should 
consult with the State Historic Preservation Officer. The applicant 
should contact OCS early in the development of its application for 
instructions regarding compliance with the Act and data required to be 
submitted to DHHS.
    In the case of projects proposed for funding which mobilize or 
improve the coordination of existing public and private food assistance 
resources, the guidelines governing those resources apply. However, in 
the case of projects providing direct assistance to beneficiaries 
through grants funded under this program, beneficiaries must fall 
within the official DHHS Poverty Income Guidelines as set forth in 
Attachment A.
    Applications which propose the use of grant funds for the 
development of any printed or visual materials must contain convincing 
evidence that these materials are not available from other sources. OCS 
will not provide funding for such items if justification is not 
sufficient. Approval of any films or visual presentations proposed by 
applicants approved for funding will be made part of the grant award. 
In cases where material outlays for equipment (audio and visual) are 
requested, specific evidence must be presented that there is a definite 
programmatic connection between the equipment (audio and visual) usage 
and the outreach requirements described in Part A-3 of this 
Announcement.
    OCS is also interested in projects that address the needs of 
homeless families and welcomes applications which seek to develop 
innovative approaches to promote health, and nutritional awareness 
among low-income populations.

Part D--Review Criteria

    Applications which pass the initial screening and pre-rating review 
(See Part F, Section 5) will be assessed and scored by reviewers. Each 
reviewer will give a numerical score for each application reviewed. 
These numerical scores will be supported by explanatory statements on a 
formal rating form describing major strengths and weaknesses under each 
applicable Criterion published in the Announcement.
    The in-depth evaluation and review process will use the following 
criteria coupled with the specific requirements as described in Part F.
    When writing their Project Narrative applicants should respond to 
the review criteria using the same sequential order.

    Note: The following review criteria reiterate the information 
requirements contained in Part B of this Announcement.

Criteria for Review and Evaluation of Applications Submitted Under This 
Program Announcement

Criterion I

Analysis of Needs/Priorities (Maximum: 10 Points)
    (a) Target area and population to be served are adequately 
described (0-4 Points).
    In addressing the above Criterion, the applicant should include a 
description of the target area and population to be served including 
specific details on any minority population(s) to be served.
    (b) Nature and extent of problem(s) and/or need(s) to be addressed 
are adequately described and documented (0-6 Points).
    In addressing the above Criterion, the applicant should include a 
discussion of the nature and extent of the problem(s) and/or need(s), 
including specific information on minority populations(s).

Criterion II

Adequacy of Work Program (Maximum: 25 Points)
    (a) Realistic quarterly time targets are set forth by which the 
various work tasks will be completed (0-10 Points).
    (b) Activities are adequately described and appear reasonably 
likely to achieve results which will have a desired impact on the 
identified problems and/or needs (0-15 Points).
    In addressing the above Criterion, the applicant should address the 
basic criteria and legislatively-mandated activities found in Part A-4 
and should include:
    1. Project priorities and rationale for selecting them which relate 
to the specific nutritional problem(s) and/or need(s) of the target 
population which were identified under Criterion I;
    2. Goals and objectives which speak to the(se) problem(s) and/or 
need(s); and
    3. Project activities which if successfully carried out can be 
reasonably expected to result in the achievement of these goals and 
objectives.

Criterion III

Significant and Beneficial Impact (Maximum: 30 Points)
    (a) Applicant proposes to significantly improve or increase 
nutrition services to low-income people and such improvements or 
increases are quantified (0-15 Points).
    (b) Project incorporates promotional health and social services 
activities for low-income people, along with nutritional services (0-5 
Points).
    (c) Project will significantly leverage or mobilize other community 
resources and such resources are detailed and quantified (0-5 Points).
    (d) Project addresses problem(s) which can be resolved by one-time 
OCS funding or demonstrates that non-Federal funding is available to 
continue the project without Federal support (0-5 Points).
    In addressing the above Criterion, the applicant must include 
quantitative data for Items (a), (b), and (c), and discuss how the 
beneficial impact relates to the relevant legislatively-mandated 
program activities identified in Part A-1 and the problems and/or needs 
described under Criterion I.

Criterion IV

Coordination/Services Integration (Maximum: 15 Points)
    (a) Project shows evidence of coordinated community-based planning 
in its development, including strategies in the Work Program to carry 
on

[[Page 13627]]

activities in collaboration with other locally funded Federal programs 
(such as DHHS health and social services and USDA Food and Consumer 
Service programs) in ways that will eliminate duplication and will, for 
example, (1) unite funding streams at the local level to increase 
program outreach and effectiveness, (2) facilitate access to other 
needed social services by coordinating and simplifying intake and 
eligibility certification processes for clients, or (3) bring project 
participants into direct interaction with holistic family development 
resources in the community where needed. (0-10 Points).
    (b) Community Empowerment Consideration--Special consideration will 
be given to applicants who are located in areas which are characterized 
by poverty and other indicators of socio-economic distress such as a 
poverty rate of at least 20 percent, designation as an Empowerment Zone 
or Enterprise Community, high levels of unemployment, and high levels 
of incidences of violence, gang activity, crime, or drug use. 
Applicants should document that they were involved in the preparation 
and planned implementation of a comprehensive community-based strategic 
plan to achieve both economic and human development in an integrated 
manner. (0-5 Points).
    If the applicant is receiving funds from the State for community 
food and nutrition activities, the applicant should address how the 
funds are being utilized, and how they will be coordinated with the 
proposed project to maximize the effectiveness of both. If State funds 
are being used in the project for which OCS funds are being requested, 
their usage should be specifically described.

Criterion V

Organization Experience in Program Area and Staff Responsibilities 
(Maximum 15 Points)
    (a) Organizational experiences in program area (0-5 Points).
    Documentation provided indicates that projects previously 
undertaken have been relevant and effective and have provided permanent 
benefits to the low-income population. Organizations which propose 
providing training and technical assistance have detailed competence in 
the program area and as a deliverer with expertise in the fields of 
training and technical assistance. If applicable, information provided 
by these applicants also addresses related achievements and competence 
of each cooperating or sponsoring organization.
    (b) Management History (0-5 Points).
    Applicants must demonstrate their ability to implement sound and 
effective management practices and if they have been recipients of 
other Federal or other governmental grants, they must also document 
that they have consistently complied with financial and program 
progress reporting and audit requirements. Such documentation may be in 
the form of references to any available audit or progress reports and 
should be accompanied by a statement by a Certified or Licensed Public 
Accountant as to the sufficiency of the applicant's financial 
management system to protect adequately any Federal funds awarded under 
the application submitted.
    (c) Staffing Skills, Resources and Responsibilities (0-5 Points).
    The application adequately describes the experience and skills of 
the proposed project director showing that the individual is not only 
well qualified, but that his/her professional capabilities are relevant 
to the successful implementation of the project. If the key staff 
person has not yet been identified, the application contains a 
comprehensive position description which indicates that the 
responsibilities to be assigned to the project director are relevant to 
the successful implementation of the project. The application must 
indicate that the applicant has adequate facilities and resources (i.e. 
space and equipment) to successfully carry out the work plan.
    In addressing the above Criterion, the applicant must clearly show 
that sufficient time of the Project Director and other senior staff 
will be budgeted to assure timely implementation and oversight of the 
project and that the assigned responsibilities of the staff are 
appropriate to the tasks identified for the project.

Criterion VI

Adequacy of Budget (Maximum: 5 Points)
    The budget is adequate and administrative costs are appropriate in 
relation to the services proposed. (0-5 Points)

Part E--Instructions for Completing Application Package

    The standard forms attached to this Announcement shall be used when 
submitting applications for all funds under this Announcement. It is 
recommended that you reproduce single-sided copies of the SF-424, SF-
424A and SF-424B, and type your application on the copies. Please 
prepare your application in accordance with instructions provided on 
the forms as well as with the OCS specific instructions set forth 
below:

1. SF-424--Application for Federal Assistance (Attachment B-1)

    Item 1. Type of Submission--For the purposes of this Announcement, 
all projects are considered Applications; there are no Pre-
Applications.
    Item 2. Date Submitted and Applicant Identifier--Enter the date the 
application is submitted to the Administration for Children and 
Families (ACF) and the applicant's internal control number, if 
applicable.
    Item 3. Date Received by State--N/A.
    Item 4. Date Received by Federal Agency--Leave blank.
    Items 5. & 6. Applicant Information & Employer Identification 
Number--The legal name of the applicant must match that listed as 
corresponding to the Employer Identification Number. Where the 
applicant is a previous DHHS grantee, enter the Central Registry 
System/Employee Identification Number (CRS/EIN) and the Payment 
Identifying Number (PIN), if one has been assigned, in the Block 
entitled Federal Identifier located at the top right hand corner of the 
form.
    Item 7. Type of Applicant--If the applicant is a non-profit 
corporation, enter the letter ``N'' in the box and specify non-profit 
corporation in the space marked ``Other''. Proof of non-profit status, 
such as IRS certification, Articles of Incorporation, or By-laws, must 
be included as an appendix to the project narrative.
    Item 8. Type of Application--Check ``New''.
    Item 9. Name of Federal Agency--Enter ``DHHS-ACF/OCS''.
    Item 10. The Catalog of Federal Domestic Assistance (CFDA) Number--
The CFDA number for the OCS program covered under this Announcement is 
93.571. The title is ``Community Services Block Grant Discretionary 
Awards--Community Food and Nutrition Program''.
    Item 11. Descriptive Title of Project--Enter a brief descriptive 
title of the project.
    Item 12. Areas Affected by Project--List only the largest unit or 
units affected, such as State, county or city.
    Item 13. Proposed Project Dates--Show 12-month project period. (See 
Part B-3) In addition, the project period start date must be on or 
before September 30, 1997.
    Item 14. Congressional District of Applicant/Project--Enter the 
number(s) of the Congressional District where the applicant's principal 
office is located and the number(s) of the Congressional

[[Page 13628]]

District(s) where the project will be located.
    Item 15. Estimated Funding--(15a.) Show the total amount requested 
for the entire project period; (15b. thru 15e.) For each line item, 
show both cash and third-party in-kind contributions for the total 
project period; (15f.) Show the estimated amount of program income for 
the total project period; (15g.) Enter the sum of all the lines.

2. SF-424A--Budget Information--Non-Construction Programs (Attachment 
B-2)

    See the Instructions accompanying the Attachment as well as the 
Instructions set forth below.
    In completing these sections, the Federal Funds budget entries will 
relate to the requested OCS Community Food and Nutrition Program funds 
only, and Non-Federal will include mobilized funds from all other 
sources--applicants, State, and other. Federal funds other than those 
requested from the Community Food and Nutrition Program should be 
included in Non-Federal entries.
    Sections A and D of SF-424A must contain entries for both Federal 
(OCS) and non-Federal (mobilized) funds.

Section A--Budget Summary

Lines 1-4
    Column (a) Line 1--Enter OCS CFN Program.
    Column (b) Line 1--Enter 93.571.
    Columns (c) and (d)--Not Applicable.
    Columns (e), (f) and (g)--For lines 1 through 4, enter in 
appropriate amounts needed to support the project for the entire 
project period.
Line 5
    Enter the figures from Line 1 for all columns completed, (e), (f), 
and (g).

Section B--Budget Categories

    This section should contain entries for OCS funds only. For all 
projects, the first budget period of 12 months will be entered in 
Column (1).
    Allocability of costs is governed by applicable cost principles set 
forth in the Code of Federal Regulations (CFR), Title 45, Parts 74 and 
92.
    Budget estimates for administrative costs must be supported by 
adequate detail for the grants officer to perform a cost analysis and 
review. Adequately detailed calculations for each budget object class 
are those which reflect estimation methods, quantities, unit costs, 
salaries, and other similar quantitative detail sufficient for the 
calculation to be duplicated. For any additional object class 
categories included under the object class other, identify the 
additional object class(es) and provide supporting calculations.
    Supporting narratives and justifications are required for each 
budget category, with emphasis on unique/special initiatives; large 
dollar amounts; local, regional, or other travel; new positions; major 
equipment purchases; and training programs.
    A detailed itemized budget with a separate budget justification for 
each major item should be included as indicated below:
Line 6a
    Personnel--Enter the total costs of salaries and wages.
    Justification--Identify the project director. Specify by title or 
name the percentage of time allocated to the project, the individual 
annual salaries and the cost to the project (both Federal and non-
Federal) of the organization's staff who will be working on the 
project.
Line 6b
    Fringe Benefits--Enter the total costs of fringe benefits unless 
treated as part of an approved indirect cost rate which is entered on 
Line 6j.
    Justification--Enter the total costs of fringe benefits, unless 
treated as part of an approved indirect cost rate.
Line 6c
    Travel--Enter total cost of all travel by employees of the project. 
Do not enter costs for consultant's travel.
    Justification--Include the name(s) of traveler(s), total number of 
trips, destinations, length of stay, mileage rate, transportation costs 
and subsistence allowances.
Line 6d
    Equipment--Enter the total costs of all equipment to be acquired by 
the project. Equipment means an article of nonexpendable, tangible 
personal property having a useful life of more than one year and an 
acquisition cost which equals or exceeds the lesser of (a) the 
capitalization level established by the organization for financial 
statement purposes, or (b) $5,000.

    [Note: If an applicant's current rate agreement was based on 
another definition for equipment, such as ``tangible personal 
property $500 or more'', the applicant shall use the definition used 
by the cognizant agency in determining the rate(s). However, 
consistent with the applicant's equipment policy, lower limits may 
be set.]

    Justification--Equipment to be purchased with Federal funds must be 
required to conduct the project, and the applicant organization or its 
subgrantees must not already have the equipment or a reasonable 
facsimile available to the project.
Line 6e
    Supplies--Enter the total costs of all tangible personal property 
(surplus) other than that included on line 6d.
Line 6f
    Contractual--Enter the total costs of all contracts, including (1) 
procurement contracts (except those which belong on other lines such as 
equipment, supplies, etc.) and (2) contracts with secondary recipient 
organizations including delegate agencies and specific project(s) or 
businesses to be financed by the applicant.
    Justification--Attach a list of contractors, indicating the names 
of the organizations, the purposes of the contracts, the estimated 
dollar amounts, and selection process of the awards as part of the 
budget justification. Also provide back-up documentation identifying 
the name of contractor, purpose of contract, and major cost elements.

    Note: Whenever the applicant/grantee intends to delegate part of 
the program to another agency, the applicant/grantee must submit 
Sections A and B of this Form SF-424A, completed for each delegate 
agency by agency title, along with the required supporting 
information referenced in the applicable instructions. The total 
costs of all such agencies will be part of the amount shown on Line 
6f. Provide draft Request for Proposal in accordance with 45 CFR 
Part 74, Appendix A. All procurement transactions shall be conducted 
in a manner to provide, to the maximum extent practical, open and 
free competition.
Line 6g
    Construction--Not applicable.
Line 6h
    Other--Enter the total of all other costs. Such costs, where 
applicable, may include, but are not limited to, insurance, food, 
medical and dental costs (non-contractual), fees and travel paid 
directly to individual consultants, local transportation (all travel 
which does not require per diem is considered local travel), space and 
equipment rentals, printing and publication, computer use training 
costs including tuition and stipends, training service costs including 
wage payments to individuals and supportive service payments, and staff 
development costs.
Line 6j
    Indirect Charges--Enter the total amount of indirect costs. This 
line should be used only when the applicant currently has an indirect 
cost rate approved by DHHS or other Federal agencies.
    If the applicant organization is in the process of initially 
developing or

[[Page 13629]]

renegotiating a rate, it should, immediately upon notification that an 
award will be made, develop a tentative indirect cost rate proposal 
based on its most recently completed fiscal year in accordance with the 
principles set forth in the pertinent DHHS Guide for Establishing 
Indirect Cost Rates and submit it to the appropriate DHHS Regional 
Office. It should be noted that when an indirect cost rate is 
requested, those costs included in the indirect cost pool cannot be 
also budgeted or charged as direct costs to the grant. Indirect costs 
consistent with approved Indirect Cost Rate Agreements are allowable.
Line 6k
    Totals--Enter the total amount of Lines 6i and 6j.
Line 7
    Program Income--Enter the estimated amount of income, if any, 
expected to be generated from this project. Separately show expected 
program income generated from OCS support and income generated from 
other mobilized funds. Do not add or subtract this amount from the 
budget total. Show the nature and source of income in the program 
narrative statement.
    Justification--Describe the nature, source and anticipated use of 
program income in the Program Narrative Statement.

Section C--Non-Federal Resources

    This section is to record the amounts of Non-Federal resources that 
will be used to support the project. Non-Federal resources mean other 
than OCS funds for which the applicant has received a commitment. 
Provide a brief explanation, on a separate sheet, showing the type of 
contribution, broken out by Object Class Category, (See SF-424A, 
Section B.6) and whether it is cash or third-party in-kind. The firm 
commitment of these required funds must be documented and submitted 
with the application in order to be given credit in the Criterion.
    Except in unusual situations, this documentation must be in the 
form of letters of commitment or letters of intent from the 
organization(s)/individuals from which funds will be received.
Line 8
    Column (a)--Enter the project title.
    Column (b)--Enter the amount of cash or donations to be made by the 
applicant.
    Column (c)--Enter the State contribution.
    Column (d)--Enter the amount of cash and third party in-kind 
contributions to be made from all other sources.
    Column (e)--Enter the total of columns (b), (c), and (d).
Lines 9, 10 and 11
    Leave Blank.
Line 12
    Carry the total of each column of Line 8, (b) through (e). The 
amount in Column (e) should be equal to the amount on Section A, Line 
5, Column (f).
    Justification--Describe third party in-kind contributions, if 
included.

Section D--Forecasted Cash Needs

Line 13
    Federal--Enter the amount of Federal (OCS) cash needed for this 
grant, by quarter, during the 12 month budget period.
Line 14
    Non-Federal--Enter the amount of cash from all other sources needed 
by quarter during the first year.
Line 15
    Totals--Enter the total of Lines 13 and 14.

Section F--Other Budget Information

Line 21
    Direct Charges--Include narrative justification required under 
Section B for each object class category for the total project period.
Line 22
    Indirect Charges--Enter the type of DHHS or other Federal agency 
approved indirect cost rate (provisional, predetermined, final or 
fixed) that will be in effect during the funding period, the estimated 
amount of the base to which the rate is applied and the total indirect 
expense. Also, enter the date the rate was approved, where applicable. 
Attach a copy of the approved rate agreement.
Line 23
    Provide any other explanations and continuation sheets required or 
deemed necessary to justify or explain the budget information.

3. SF-424B--Assurances Non-Construction Programs (Attachment B-3)

    All applicants must sign and return the ``Assurances'' with the 
application.

4. Project Narrative

    Each narrative should include the following major sections:
    a. Analysis of Need.
    b. Project Design (Work Program).
    c. Organizational Experience in the Program Area.
    d. Management History.
    e. Staffing and Resources.
    f. Staff Responsibilities.
    The project narrative must address the specific purposes mentioned 
in Part A of this Program Announcement. The narrative should provide 
information on how the application meets the evaluation criteria in 
Part D of this Program Announcement.

Part F--Application Procedures

1. Availability of Forms

    Applications for awards under this OCS program must be submitted on 
Standard Forms (SF) 424, 424A, and 424B. Part E and the Attachments to 
this Program Announcement contain all the instructions and forms 
required for submittal of applications. The forms may be reproduced for 
use in submitting applications.
    A copy of the Federal Register containing this Announcement is 
available for reproduction at most local libraries and Congressional 
District Offices. It is also available on the Internet through GPO 
Access at the following web address: <a href="http://www.access.gpo.gov/
su__docs/aces/aces140.html">http://www.access.gpo.gov/
su__docs/aces/aces140.html</a> If this Program Announcement is not 
available at these sources it may be obtained by telephoning the office 
listed in the section entitled FOR FURTHER INFORMATION CONTACT at the 
beginning of this Announcement.
    The information requested under this Program Announcement is 
covered under the following OMB information collection clearances: SF-
424 (No. 0348-0043), SF-424A (No. 0348-0044), SF-424B (No. 0348-0040), 
and other requirements for OCS applications (No. 0970-0062).

2. Application Submission

    Applications, once submitted, are considered final and no 
additional materials will be accepted.
    Applicants must submit one signed original application and four 
copies.

3. Intergovernmental Review

    This program is covered under Executive Order 12372, 
``Intergovernmental Review of Federal Programs,'' and 45 CFR Part 100, 
``Intergovernmental Review of Department of Health and Human Services 
Program and Activities.'' Under the Order, States may design their own 
processes for reviewing and commenting on proposed Federal assistance 
under covered programs.
    As of September, 1996, the following jurisdictions have elected not 
to

[[Page 13630]]

participate in the Executive Order process. Applicants from these 
jurisdictions or for projects administered by Federally-recognized 
Indian Tribes need take no action in regard to E.O. 12372:

Alabama
Alaska
Colorado
Connecticut
Hawaii
Idaho
Kansas
Louisiana
Massachusetts
Minnesota
Montana
Nebraska
New Jersey
Oklahoma
Oregon
Pennsylvania
South Dakota
Tennessee
Vermont
Virginia
Washington
American Samoa
Palau

    All remaining jurisdictions participate in the Executive Order 
process and have established Single Points of Contact (SPOCs). 
Applicants from participating jurisdictions should contact their SPOCs 
as soon as possible to alert them of the prospective applications and 
receive instructions. Applicants must submit any required material to 
the SPOCs as soon as possible so that the program office can obtain and 
review SPOC comments as part of the award process. The applicant must 
submit all required materials, if any, to the SPOC and indicate the 
date of this submittal (or the date of contact if no submittal is 
required) on the Standard Form 424, item 16a.
    Under 45 CFR 100.8(a)(2), a SPOC has 60 days from the application 
deadline to comment on the proposed new award.
    The SPOCs are encouraged to eliminate the submission of routine 
endorsements as official recommendations.
    Additionally, SPOCs are requested to clearly differentiate between 
mere advisory comments and those official State process recommendations 
which may trigger the ``accommodate or explain'' rule.
    When comments are submitted directly to ACF, they should be 
addressed to: Department of Health and Human Services, Administration 
for Children and Families, Division of Discretionary Grants, 370 
L'Enfant Promenade, S.W., Mail Stop 6C-462, Washington, D.C. 20447
    A list of the Single Points of Contact for each State and Territory 
is included as Attachment G of this Announcement.

4. Application Consideration

    Applications which meet the screening requirements in Section 5 
below will be reviewed competitively. Such applications will be 
referred to reviewers for a numerical score and explanatory comments 
based solely on responsiveness to program guidelines and evaluation 
criteria published in this Announcement. Applications will be reviewed 
by persons outside of the OCS unit which would be directly responsible 
for programmatic management of the grant. The results of these reviews 
will assist the Director and OCS program staff in considering competing 
applications. Reviewers' scores will weigh heavily in funding decisions 
but will not be the only factors considered. Applications will 
generally be considered in order of the average scores assigned by 
reviewers. However, highly ranked applications are not guaranteed 
funding since the Director may also consider other factors deemed 
relevant including, but not limited to, the timely and proper 
completion of projects funded with OCS funds granted in the last five 
(5) years; comments of reviewers and government officials; staff 
evaluation and input; geographic distribution; previous program 
performance of applicant; compliance with grant terms under previous 
DHHS grants; audit reports; investigative reports; and applicant's 
progress in resolving any final audit disallowances on OCS or other 
Federal agency grants. OCS reserves the right to discuss applications 
with other Federal or non-Federal funding sources to ascertain the 
applicant's performance record.

5. Criteria for Screening Applications

    a. Initial Screening--All applications that meet the application 
deadline will be screened to determine completeness and conformity to 
the requirements of this Announcement. Only those applications meeting 
the below listed requirements will be reviewed and evaluated 
competitively. Others will be returned to the applicants with a 
notation that they were unacceptable.
    (1) The application must contain a completed and signed Standard 
Form SF-424.
    (2) The SF-424 must be signed by an official of the organization 
applying for the grant who has authority to obligate the organization 
legally.
    b. Pre-Rating Review--Applications which pass the initial screening 
will be forwarded to reviewers for analytical comment and scoring based 
on the criteria detailed in the Section below and the specific 
requirements contained in Part A of this Announcement. Prior to the 
programmatic review, these reviewers and/or OCS staff will verify that 
the applications comply with this Program Announcement in the following 
areas:
    (1) Eligibility--Applicant meets the eligibility requirements found 
in Part B.
    (2) Number of Projects--The application contains only one project.
    (3) Target Populations--The application clearly targets the 
specific outcomes and benefits of the project to low-income 
participants and beneficiaries as defined in the DHHS Poverty Income 
Guidelines (Attachment A).
    (4) Grant Amount--The amount of funds requested does not exceed 
$50,000.
    (5) Program Focus--The application addresses the purposes described 
in Part A of this Announcement.
    c. Evaluation Criteria--Applications which pass the initial 
screening and pre-rating review will be assessed and scored by 
reviewers. Each reviewer will give a numerical score for each 
application reviewed. These numerical scores will be supported by 
explanatory statements on a formal rating form describing major 
strengths and major weaknesses under each applicable Criterion 
published in this Announcement.

Part G--Contents of Application Package and Receipt Process

1. Contents of Application

    Each application submission must include a signed original and four 
additional copies of the application. Each copy of the application must 
contain, in the order listed, each of the following:
    a. Table of Contents with page numbers noted for each major section 
and subsection of the application, including the appendices. Each page 
in the application, including those in all appendices, must be numbered 
consecutively.
    b. A Project Abstract which is a succinct description of the 
project in 200 words or less.
    c. The SF-424 (Application for Federal Assistance) should be 
completed in accordance with instructions provided with the form, as 
well as OCS specific instructions set forth in Part E of this 
Announcement. The SF-424 must contain an original signature of the 
certifying representative of the applicant organization. Applicants 
must also be aware that the

[[Page 13631]]

applicant's legal name (Item 5) must match the Employer Identification 
Number (Item 6).
    d. SF-424A (Budget Information) must be completed.
    e. SF-424B (Assurances--Non-Construction Programs) must be filed by 
applicants requesting financial assistance for a non-construction 
project. Applicants must sign and return the SF-424B with their 
applications.
    f. Restriction on Lobbying Activities Applicants must provide a 
certification concerning lobbying. Prior to receiving an award in 
excess of $100,000, applicants shall furnish an executed copy of the 
lobbying certification. Applicants must sign and return the 
certification with their applications.
    g. Disclosure of Lobbying Activities (SF-LLL) Fill-in, sign and 
date form found at Attachment F, (required only if lobbying has 
actually taken place or is expected to take place in trying to obtain 
the grant for which the applicant is applying.)
    h. Project Narrative (See Part E, Section 4)
    i. Certification Regarding Drug-Free Workplace Requirements 
(Attachment C) Applicants must make the appropriate certification of 
their compliance with the Drug-Free Workplace Act of 1988. By signing 
and submitting the applications, applicants are providing the 
certification and need not mail back the certification with the 
applications.
    j. Certification Regarding Debarment, Suspension, Etc. (Attachment 
D) Applicants must make the appropriate certification that they are not 
presently debarred, suspended or otherwise ineligible for award. By 
signing and submitting the applications, applicants are providing the 
certification and need not mail back the certification with the 
applications.
    k. Certification Regarding Environmental Tobacco Smoke (Attachment 
E) Applicants must make the appropriate certification of their 
compliance with the Pro-Children Act of 1944. By signing and submitting 
the applications, applicants are providing the certification and need 
not mail back the certification with the applications.
    The total number of pages for the narrative portion of the 
application package must not exceed 30 pages in their entirety. 
Applications must be uniform in composition since OCS may find it 
necessary to duplicate them for review purposes. Therefore, 
applications must be submitted on 8\1/2\ 11-inch paper only. They must 
not include colored, oversized or folded materials, organizational 
brochures, or other promotional materials, slides, films, clips, etc. 
Such materials will be discarded if included.
    Applications should be two-holed punched at the top center and 
fastened separately with a compressor slide paper fastener or a binder 
clip.
    While applications must be comprehensive, OCS encourages 
conciseness and brevity in the presentation of materials and cautions 
the applicant to avoid unnecessary duplication of information.

2. Acknowledgement of Receipt

    An acknowledgement will be mailed to all applicants with an 
identification number which will be noted on the acknowledgement. This 
number must be referred to in all subsequent communications with OCS 
concerning the application. If an acknowledgment is not received within 
three weeks after the application deadline, applicants must notify ACF 
by telephone (202) 401-9365. Applicant should also submit a mailing 
label for the acknowledgement.

Part H--Post Award Information and Reporting Requirements

    Following approval of the applications selected for funding, notice 
of project approval and authority to draw down project funds will be 
made in writing. The official award document is the Financial 
Assistance Award which provides the amount of Federal funds approved 
for use in the project, the budget period for which support is 
provided, and the terms and conditions of the award.
    In addition to the General Conditions and Special Conditions (where 
the latter are warranted) which will be applicable to grants, grantees 
will be subject to the provisions of 45 CFR Parts 74 (non-governmental) 
and 92 (governmental) along with Circulars 122 (non-governmental) and 
87 (governmental).
    Grantees will be required to submit semi-annual progress and 
financial reports (SF-269) as well as a final progress and financial 
report.
    Grantees are subject to the audit requirements in 45 CFR Parts 74 
and 92.
    Section 319 of Public Law 101-121, signed into law on October 23, 
1989, imposes new prohibitions and requirements for disclosure and 
certification related to lobbying when applicant has engaged in 
lobbying activities or is expected to lobby in trying to obtain the 
grant. It provides limited exemptions for Indian tribes and tribal 
organizations. Current and prospective recipients (and their subtier 
contractors and/or grantees) are prohibited from using appropriated 
funds for lobbying Congress or any Federal agency in connection with 
the award of a contract, grant, cooperative agreement or loan. In 
addition, for each award action in excess of $100,000 (or $150,000 for 
loans) the law requires recipients and their subtier contractors and/or 
subgrantees (1) to certify that they have neither used nor will use any 
appropriated funds for payment to lobbyists, (2) to submit a 
declaration setting forth whether payments to lobbyists have been or 
will be made out of non-appropriated funds and, if so, the name, 
address, payment details, and purpose of any agreements with such 
lobbyists whom recipients or their subtier contractors or subgrantees 
will pay with the nonappropriated funds and (3) to file quarterly up-
dates about the use of lobbyists if any event occurs that materially 
affects the accuracy of the information submitted by way of declaration 
and certification. The law establishes civil penalties for 
noncompliance and is effective with respect to contracts, grants, 
cooperative agreements and loans entered into or made on or after 
December 23, 1989. See Attachment F for certification and disclosure 
forms to be submitted with the applications for this program.
    Attachment H indicates the regulations which apply to all 
applicants/grantees under the Discretionary Grants Program.

    Dated: March 17, 1997.
Donald Sykes,
Director, Office of Community Services.

Attachment A

1995 Poverty Income Guidelines for All States (Except Alaska and Hawaii)
                      and the District of Columbia                      
------------------------------------------------------------------------
                                                               Poverty  
                    Size of family unit                       guideline 
------------------------------------------------------------------------
1..........................................................       $7,470
2..........................................................       10,030
3..........................................................       12,590
4..........................................................       15,150
5..........................................................       17,710
6..........................................................       20,270
7..........................................................       22,830
8..........................................................       25,390
------------------------------------------------------------------------
For family units with more than 8 members, add $2,580 for each          
  additional member. (The same increment applies to smaller family sizes
  also, as can be seen in the figures above.)                           


[[Page 13632]]


                  Poverty Income Guidelines For Alaska                  
------------------------------------------------------------------------
                                                               Poverty  
                    Size of family unit                       guideline 
------------------------------------------------------------------------
1..........................................................       $9,340
2..........................................................       12,540
3..........................................................       15,740
4..........................................................       18,940
5..........................................................       22,140
6..........................................................       25,340
7..........................................................       28,540
8..........................................................       31,740
------------------------------------------------------------------------
For family units with more than 8 members, add $3,200 for each          
  additional member. (The same increment applies to smaller family sizes
  also, as can be seen in figures above.)                               


                  Poverty Income Guidelines For Hawaii                  
------------------------------------------------------------------------
                                                               Poverty  
                    Size of family unit                       guideline 
------------------------------------------------------------------------
1..........................................................       $8,610
2..........................................................       11,550
3..........................................................       14,490
4..........................................................       17,430
5..........................................................       20,370
6..........................................................       23,310
7..........................................................       26,250
8..........................................................       29,190
------------------------------------------------------------------------
For family units with more than 8 members, add $2,940 for each          
  additional member. (The same increment applies to smaller family sizes
  also, as can be seen in figures above.)                               


BILLING CODE 4184-01-P
      

[[Page 13633]]

[GRAPHIC] [TIFF OMITTED] TN21MR97.000



BILLING CODE 4184-01-C

[[Page 13634]]

Instructions for the SF 424

    Public reporting burden for this collection of information is 
estimated to average 45 minutes per response, including time for 
reviewing instructions, searching existing data sources, gathering 
and maintaining the data needed, and completing and reviewing the 
collection of information. Send comments regarding the burden 
estimate or any other aspect of this collection of information, 
including suggestions for reducing this burden, to the Office of 
Management and Budget. Paperwork Reduction Project (0348-0043), 
Washington, DC 20503.
    Please do not return your completed form to the Office of 
Management and Budget, send it to the address provided by the 
sponsoring agency.
    This is a standard form used by applicants as a required 
facesheet for preapplications and applications submitted for Federal 
assistance. It will be used by Federal agencies to obtain applicant 
certification that States which have established a review and 
comment procedure in response to Executive Order 12372 and have 
selected the program to be included in their process, have been 
given an opportunity to review the applicant's submission.

Item and Entry

    1. Self-explanatory.
    2. Date application submitted to Federal agency (or State, if 
applicable) & applicant's control number (if applicable).
    3. State use only (if applicable).
    4. If this application is to continue or revise an existing 
award, enter present Federal identifier number. If for a new 
project, leave blank.
    5. Legal name of applicant, name of primary organizational unit 
which will undertake the assistance activity, complete address of 
the applicant, and name and telephone number of the person to 
contact on matters related to this application.
    6. Enter Employer Identification Number (EIN) as assigned by the 
Internal Revenue Service.
    7. Enter the appropriate letter in the space provided.
    8. Check appropriate box and enter appropriate letter(s) in the 
space(s) provided:

--``New'' means a new assistance award.
--``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
--``Revision'' means any change in the Federal Government's 
financial obligation or contingent liability from an existing 
obligation.

    9. Name of Federal agency from which assistance is being 
requested with this application.
    10. Use the Catalog of Federal Domestic Assistance number and 
title of the program under which assistance is required.
    11. Enter a brief descriptive title of the project. If more than 
one program is involved, you should append an explanation on a 
separate sheet. If appropriate (e.g., construction or real property 
projects), attach a map showing project location. For 
preapplications, use a separate sheet to provide a summary 
description of this project.
    12. List only the largest political entities affected (e.g., 
State, counties, cities.)
    13. Self-explanatory.
    14. List the applicant's Congressional District and any 
District(s) affected by the program or project.
    15. Amount requested or to be contributed during the first 
funding/budget period by each contributor. Value of in-kind 
contributions should be included on appropriate lines as applicable. 
If the action will result in a dollar change to an existing award, 
include only the amount of the change. For decreases, enclose the 
amounts in parentheses. If both basic and supplemental amounts are 
included, show breakdown on an attached sheet. For multiple program 
funding, use totals and show breakdown using same categories as item 
15.
    16. Applicants should contact the State Single Point of Contact 
(SPOC) for Federal Executive Order 12372 to determine whether the 
application is subject to the State intergovernmental review 
process.
    17. 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.
    18. To be signed by the authorized representative of the 
applicant. A copy of the governing body's authorization for you to 
sign this application as official representative must be on file in 
the applicant's office. (Certain Federal agencies may require that 
this authorization be submitted as part of the application.)

BILLING CODE 4184-01-M

[[Page 13635]]

[GRAPHIC] [TIFF OMITTED] TN21MR97.001



[[Page 13636]]

[GRAPHIC] [TIFF OMITTED] TN21MR97.002



BILLING CODE 4184-01-C

[[Page 13637]]

Instructions for the SF 424A

    Public reporting burden for this collection of information is 
estimated to average 180 minutes per response, including time for 
reviewing instructions, searching existing data sources, gathering 
and maintaining the data needed, and completing and reviewing the 
collection of information. Send comments regarding the burden 
estimate or any other aspect of this collection of information, 
including suggestions for reducing this burden, to the Office of 
Management and Budget, Paperwork Reduction Project (0348-0043), 
Washington, DC 20503.
    Please do not return your completed form to the Office of 
Management and Budget, send it to the address provided by the 
sponsoring agency.

General Instructions

    This form is designed so that application can be made for funds 
from one or more grant programs. In preparing the budget, adhere to 
any existing Federal grantor agency guidelines which prescribe how 
and whether budgeted amounts should be separately shown for 
different functions or activities within the program. For some 
programs, grantor agencies may require budgets to be separately 
shown by function or activity. For other programs, grantor agencies 
may require a breakdown by function or activity. Sections A, B, C, 
and D should include budget estimates for the whole project except 
when applying for assistance which requires Federal authorization in 
annual or other funding period increments. In the latter case, 
Sections A, B, C, and D should provide the budget for the first 
budget period (usually a year) and Section E should present the need 
for Federal assistance in the subsequent budget periods. All 
applications should contain a breakdown by the object class 
categories shown in Lines a-k of Section B.

Section A. Budget Summary

Lines 1-4, Columns (a) and (b)

    For applications pertaining to a single Federal grant program 
(Federal Domestic Assistance Catalog number) and not requiring a 
functional or activity breakdown, enter on Line 1 under Column (a) 
the catalog program title and the catalog number in Column (b).
    For applications pertaining to a single program requiring budget 
amounts by multiple function or activities, enter the name of each 
activity or function on each line in Column (a), and enter the 
catalog number in Column (b). For applications pertaining to 
multiple programs where none of the programs require a breakdown by 
function or activity, enter the catalog program title on each line 
in Column (a) and the respective catalog number of each line in 
Column (b).
    For applications pertaining to multiple programs where one or 
more programs require a breakdown by function or activity, prepare a 
separate sheet for each program requiring the breakdown. Additional 
sheets should be used when one form does not provide adequate space 
for all breakdown of data required. However, when more than one 
sheet is used, the first page should provide the summary totals by 
programs.

Lines 1-4, Columns (c) through (g)

    For new applications, leave Columns (c) and (d) blank. For each 
line entry in Columns (a) and (b), enter in Columns (e), (f), and 
(g) the appropriate amounts of funds needed to support the project 
for the first funding period (usually a year).
    For continuing grant program applications, submit these forms 
before the end of each funding period as required by the grantor 
agency. Enter in Columns (c) and (d) the estimated amounts of funds 
which will remain unobligated at the end of the grant funding period 
only if the Federal grantor agency instructions provide for this. 
Otherwise, leave these columns blank. Enter in Columns (e) and (f) 
the amounts of funds needed for the upcoming period. The amount(s) 
in Column (g) should be the sum of amounts in Columns (e) and (f).
    For supplemental grants and changes to existing grants, do not 
use Columns (c) and (d). Enter in Column (e) the amount of the 
increase or decrease of Federal funds and enter in Column (f) the 
amount of the increase or decrease of non-Federal funds. In Column 
(g) enter the new total budgeted amount (Federal and non-Federal) 
which includes the total previous authorized budgeted amounts plus 
or minus, as appropriate, the amounts shown in Columns (e) and (f). 
The amount(s) in Column (g) should not equal the sum of amounts in 
Columns (e) and (f).
    Line 5--Show the total for all columns used.

Section B. Budget Categories

    In the column headings (1) through (4), enter the titles of the 
same programs, functions, and activities shown on Lines 1-4, Column 
(a), Section A. When additional sheets are prepared for Section A, 
provide similar column headings on each sheet. For each program, 
function or activity, fill in the total requirements for funds (both 
Federal and non-Federal) by object class categories.
    Lines 6a-i--Show the totals of Lines 6a to 6h in each column.
    Line 6j--Show the amount of indirect cost.
    Line 6k--Enter the total of amounts on Lines 6i and 6j. For all 
applications for new grants and continuation grants the total amount 
in column (5), Line 6k, should be the same as the total amount shown 
in Section A, Column (g), Line 5. For supplemental grants and 
changes to grants, the total amount of the increase or decrease as 
shown in Columns (1)-(4), Line 6k, should be the same as the sum of 
the amounts in Section A, Columns (e) and (f) on Line 5.
    Line 7--Ener the estimated amount of income, if any, expected to 
be generated from this project. Do not add or subtract this amount 
from the total project amount. Show under the program narrative 
statement the nature and source of income. The estimated amount of 
program income may be considered by the federal grantor agency in 
determining the total amount of the grant.

Section C. Non-Federal Resources

    Lines 8-11 Enter amounts of non-Federal resources that will be 
used on the grant. If in-kind contributions are included, provide a 
brief explanation on a separate sheet.
    Column (a)--Enter the program titles identical to Column (a), 
Section A. A breakdown by function or activity is not necessary.
    Column (b)--Enter the contribution to be made by the applicant.
    Column (c)--Enter the amount of the State's cash and in-kind 
contribution if the applicant is not a State or State agency. 
Applicants which are a State or State agencies should leave this 
column blank.
    Column (d)--Enter the amount of cash and in-kind contributions 
to be made from all other sources.
    Column (e)--Enter totals in Columns (b), (c), and (d).
    Line 12--Enter the total for each of Columns (b)-(e). The amount 
in Column (e) should be equal to the amount on Line 5, Column (f), 
Section A.

Section D. Forecasted Cash Needs

    Line 13--Enter the amount of cash needed by quarter from the 
grantor agency during the first year.
    Line 14--Enter the amount of cash from all other sources needed 
by quarter during the first year.
    Line 15--Enter the totals of amounts on Lines 13 and 14.

Section E. Budget Estimates of Federal Funds Needed for Balance of 
the Project

    Lines 16-19--Enter in Column (a) the same grant program titles 
shown in Column (a), Section A. A breakdown by function or activity 
is not necessary. For new applications and continuation grant 
applications, enter in the proper columns amounts of Federal funds 
which will be needed to complete the program or project over the 
succeeding funding periods (usually in years). This section need not 
be completed for revisions (amendments, changes, or supplements) to 
funds for the current year of existing grants.
    If more than four lines are needed to list the program titles, 
submit additional schedules as necessary.
    Line 20--Enter the total for each of the Columns (b)-(e). When 
additional schedules are prepared for this Section, annotate 
accordingly and show the overall totals on this line.

Section F. Other Budget Information

    Line 21--Use this space to explain amounts for individual direct 
object-class cost categories that may appear to be out of the 
ordinary or to explain the details as required by the Federal 
grantor agency.
    Line 22--Enter the type of indirect rate (provisional, 
predetermined, final or fixed) that will be in effect during the 
funding period, the estimated amount of the base to which the rate 
is applied, and the total indirect expense.
    Line 23--Provide any other explanations or comments deemed 
necessary.

Attachment B-3--Assurances--Non-Construction Programs

    Public reporting burden for this collection of information is 
estimated to average 15 minutes per response, including time for 
reviewing instructions, searching existing data sources, gathering 
and maintaining the

[[Page 13638]]

data needed, and completing and reviewing the collection of 
information. Send comments regarding the burden estimate or any 
other aspect of this collection of information, including 
suggestions for reducing this burden, to the Office of Management 
and Budget, paperwork Reduction Project (0348-0043), Washington, DC 
20503.
    Please do not return your completed form to the Office of 
Management and Budget. Send it to the address provided by the 
sponsoring agency.

    Note: Certain of these assurances may not be applicable to your 
project or program. If you have questions, please contact the 
awarding agency. Further, certain Federal awarding agencies may 
require applicants to certify to additional assurances. If such is 
the case, you will be notified.

    As the duly authorized representative of the applicant I certify 
that the applicant:
    1. Has the legal authority to apply for Federal assistance and 
the institutional, managerial and financial capability (including 
funds sufficient to pay the non-Federal share of project costs) to 
ensure proper planning, management and completion of the project 
described in this application.
    2. Will give the awarding agency, the Comptroller General of the 
United States, and if appropriate, the State, through any authorized 
representative, access to and the right to examine all records, 
books, papers, or documents related to the award; and will establish 
a proper accounting system in accordance with generally accepted 
accounting standards or agency directives.
    3. Will establish safeguards to prohibit employees from using 
their positions for a purpose that constitutes or presents the 
appearance of personal or organizational conflict of interest, or 
personal gain.
    4. Will initiate and complete the work within the applicable 
time frame after receipt of approval of the awarding agency.
    5. Will comply with the Intergovernmental Personnel Act of 1970 
(42 U.S.C. Secs. 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 C.F.R. 900, Subpart F).
    6. Will comply with all Federal statutes relating to 
nondiscrimination. These include but are not limited to: (a) Title 
VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits 
discrimination on the basis of race, color or national origin; (b) 
Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 
Secs. 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. Sec. 794), which prohibits discrimination of 
the basis of handicaps; (d) the Age Discrimination Act of 1975, as 
amended (42 U.S.C. Secs. 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) Secs. 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. Secs. 3601 et seq.), as amended, relating to 
nondiscrimination in the sale, rental or financing of housing; (i) 
any other nondiscrimination provisions in the specific statute(s) 
under which application for Federal assistance is being made; and 
(j) the requirements of any other nondiscrimination statute(s) which 
may apply to the application.
    7. Will comply, or has already complied, with the requirements 
of Titles II and III of the Uniform Relocation Assistance and Real 
Property Acquisition Policies Act of 1970 (P.L. 91-646) which 
provide for fair and equitable treatment of persons displaced or 
whose property is acquired as a result of Federal or federally 
assisted programs. These requirements apply to all interests in real 
property acquired for project purposes regardless of Federal 
participation in purchases.
    8. Will comply, as applicable, with the provisions of the Hatch 
Act (5 U.S.C. Secs. 1501-1508 and 7324-7328) which limit the 
political activities of employees whose principal employment 
activities are funded in whole or in part with Federal funds.
    9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40 
U.S.C. Sec. 276c and 18 U.S.C. Sec. 874), and the Contract Work 
Hours and Safety Standards Act (40 U.S.C. Secs. 327-333), regarding 
labor standards for federally assisted construction subagreements.
    10. Will comply, if applicable, with flood insurance purchase 
requirements of Section 102(a) of the Flood Disaster Protection Act 
of 1973 (P.L. 93-234) which requires recipients in a special flood 
hazard area to participate in the program and to purchase flood 
insurance if the total cost of insurable construction and 
acquisition is $10,000 or more.
    11. Will comply with environmental standards which may be 
prescribed pursuant to the following: (a) institution of 
environmental quality control measures under the National 
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order 
(EO) 11514; (b) notification of violating facilities pursuant to EO 
11738; (c) protection of wetlands pursuant to EO 11990; (d) 
evaluation of flood hazards in floodplains in accordance with EO 
11988; (e) assurance of project consistency with the approved State 
management program developed under the Coastal Zone Management Act 
of 1972 (16 U.S.C. Secs. 1451 et seq.); (f) conformity of Federal 
actions to State (Clear Air) Implementation Plans under Section 
176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 
Secs. 7401 et seq.); (g) protection of underground sources of 
drinking water under the Safe Drinking Water Act of 1974, as amended 
(P.L. 93-523); and (h) protection of endangered species under the 
Endangered Species Act of 1973, as amended (P.L. 93-205).
    12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 
U.S.C. Secs. 1271 et seq.) related to protecting components or 
potential components of the national wild and scenic rivers system.
    13. Will assist the awarding agency in assuring compliance with 
Section 106 of the National Historic Preservation Act of 1966, as 
amended (16 U.S.C. Sec. 470), EO 11593 (identification and 
protection of historic properties), and the Archaeological and 
Historic Preservation Act of 1974 (16 U.S.C. Secs. 469a-1 et seq.).
    14. Will comply with P.L. 93-348 regarding the protection of 
human subjects involved in research, development, and related 
activities supported by this award of assistance.
    15. Will comply with the Laboratory Animal Welfare Act of 1966 
(P.L. 89-544, as amended, 7 U.S.C. Secs. 2131 et seq.) pertaining to 
the care, handling, and treatment of warm blooded animals held for 
research, teaching, or other activities supported by this award of 
assistance.
    16. Will comply with the Lead-Based Paint Poisoning Prevention 
Act (42 U.S.C. Secs. 4801 et seq.) which prohibits the use of lead-
based paint in construction or rehabilitation of residence 
structures.
    17. Will cause to be performed the required financial and 
compliance audits in accordance with the Single Audit Act of 1984 or 
OMB Circular No. A-133, Audits of Institutions of Higher Learning 
and Other Non-Profit Institutions.
    18. Will comply with all applicable requirements of all other 
Federal laws, executive orders, regulations and policies governing 
this program.

----------------------------------------------------------------------

Signature of Authorized Certifying Official

----------------------------------------------------------------------
Title

----------------------------------------------------------------------
Applicant Organization

----------------------------------------------------------------------
Date Submitted

BILLING CODE 4184-01-M

[[Page 13639]]

Attachment C
[GRAPHIC] [TIFF OMITTED] TN21MR97.003


[[Page 13640]]

[GRAPHIC] [TIFF OMITTED] TN21MR97.004



BILLING CODE 4184-01-C

[[Page 13641]]

Attachment D--Certification Regarding Debarment, Suspension, and Other 
Responsibility Matters--Primary Covered Transactions

Instructions for Certification

    1. By signing and submitting this proposal, the prospective 
primary participants is providing the certification set out below.
    2. The inability of a person to provide the certification 
required below will not necessarily result in denial of 
participation in this covered transaction. The prospective 
participant shall submit an explanation of why it cannot provide the 
certification set out below. The certification or explanation will 
be considered in connection with the department of agency's 
determination whether to enter into this transaction. However, 
failure of the prospective primary participants to furnish a 
certification or an explanation shall disqualify such person from 
participation in this transaction.
    3. The certification in this clause is a material representation 
of fact upon which reliance was placed when the department or agency 
determined to enter into this transaction. If it is later determined 
that the prospective primary participant knowingly rendered an 
erroneous certification, in addition to other remedies available to 
the Federal Government, the department or agency may terminate this 
transaction for cause or default.
    4. The prospective primary participant shall provide immediate 
written notice to the department of agency to which this proposal is 
submitted if at any time the prospective primary participant learns 
that its certification was erroneous when submitted or has become 
erroneous by reason of changed circumstances.
    5. 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. You may contact the department or agency to 
which this proposal is being submitted for assistance in obtaining a 
copy of those regulations.
    6. The prospective primary participant agrees by submitting this 
proposal that, should the proposed covered transaction be entered 
into, it shall not knowingly enter any lower tier covered 
transaction with a person who is proposed for debarment under 48 CFR 
part 9, subpart 9.4, debarred, suspended, declared ineligible, or 
voluntarily excluded from participation in this covered transaction, 
unless authorized by the department or agency entering into this 
transaction.
    7. The prospective primary participant further agrees by 
submitting this proposal that it will include the clause titled 
``Certification Regarding Debarment, Suspension, Ineligibility and 
Voluntary Exclusion-Lower Tier Covered Transaction provided by the 
department or agency entering into this covered transaction, without 
modification, in all lower tier covered transactions and in all 
solicitations for lower tier covered transactions.
    8. A participant in a covered transaction may rely upon a 
certification of a prospective participant in a lower tier covered 
transaction that it is not proposed for debarment under 48 CFR part 
9, subpart 9.4, debarred, suspended, ineligible, or voluntarily 
excluded from the covered transaction, unless it knows that the 
certification is erroneous. A participant may decide the methods and 
frequency by which it determines the eligibility of its principals. 
Each participant may, but is not required to, check the List of 
parties Excluded from Federal Procurement and Nonprocurement 
Programs.
    9. Nothing contained in the foregoing shall be construed to 
require establishment of a system of records in order to render in 
good faith the certification required by this clause. The knowledge 
and information of a participant is not required to exceed that 
which is normally possessed by a prudent person in the ordinary 
course of business dealings.
    10. Except for transactions authorized under paragraph 6 of 
these instructions, if a participant in a covered transaction 
knowingly enters into a lower tier covered transaction with a person 
who is proposed for debarment under 48 CFR part 9, subpart 9.4, 
suspended, debarred, ineligible, or voluntarily excluded from 
participation in this transaction, in addition to other remedies 
available to the Federal Government, the department or agency may 
terminate this transaction for cause or default.
* * * * *

Certification Regarding Debarment, Suspension, and Other Responsibility 
Matters--Primary Covered Transactions

    (1) The prospective primary participant certifies to the best of 
its knowledge and belief, that it and its principals:
    (a) Are not presently debarred, suspended, proposed for 
debarment, declared ineligible, or voluntarily excluded by any 
Federal department or agency;
    (b) Have not within a three-year period preceding this proposal 
been convicted of or had a civil judgment rendered against them for 
commission of fraud or a criminal offense in connection with 
obtaining, attempting to obtain, or performing a public (Federal, 
State or local) transaction or contract under a public transaction; 
violation of Federal or State antitrust statutes or commission of 
embezzlement, theft, forgery, bribery, falsification or destruction 
of records, making false statements, or receiving stolen property;
    (c) Are not presently indicted for or otherwise criminally or 
civilly charged by a governmental entity (Federal, State or local) 
with commission of any of the offenses enumerated in paragraph 
(1)(b) of this certification; and
    (d) Have not within a three-year period preceding this 
application/proposal had one or more public transactions (Federal, 
State or local) terminated for cause or default.
    (2) Where the prospective primary participant is unable to 
certify to any of the statements in this certification, such 
prospective participant shall attach an explanation to this 
proposal.

Certification Regarding Debarment, Suspension, Ineligibility and 
Voluntary Exclusion--Lower Tier Covered Transactions

Instructions for Certification

    1. By signing and submitting this proposal, the prospective 
lower tier participant is providing the certification set out below.
    2. The certification is this clause is a material representation 
of fact upon which reliance was placed when this transaction was 
entered into. If it is later determined that the prospective lower 
tier participant knowingly rendered an erroneous certification, in 
addition to other remedies available to the Federal Government the 
department or agency with which this transaction originated may 
pursue available remedies, including suspension and/or debarment.
    3. The prospective lower tier participant shall provide 
immediate written notice to the person to which this proposal is 
submitted if at any time the prospective lower tier participant 
learns that its certification was erroneous when submitted or had 
become erroneous by reason of changed circumstances.
    4. 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 meaning set out in the 
Definitions and Coverage sections of rules implementing Executive 
Order 12549. You may contact the person to which this proposal is 
submitted for assistance in obtaining a copy of those regulations.
    5. The prospective lower tier participant agrees by submitting 
this proposal that, [[Page 33043]] should the proposed covered 
transaction be entered into, it shall not knowingly enter into any 
lower tier covered transaction with a person who is proposed for 
debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, 
declared ineligible, or voluntarily excluded from participation in 
this covered transaction, unless authorized by the department or 
agency with which this transaction originated.
    6. The prospective lower tier participant further agrees by 
submitting this proposal that it will include this clause titled 
``Certification Regarding Debarment, Suspension, Ineligibility and 
Voluntary Exclusion-Lower Tier Covered Transaction,'' without 
modification, in all lower tier covered transactions and in all 
solicitations for lower tier covered transactions.
    7. A participant in a covered transaction may rely upon a 
certification of a prospective participant in a lower tier covered 
transaction that it is not proposed for debarment under 48 CFR part 
9, subpart 9.4, debarred, suspended, ineligible, or voluntarily 
excluded from covered transactions, unless it knows that the 
certification is erroneous. A participant may decide the method and 
frequency by which it determines the eligibility of its principals. 
Each participant may, but is not required to, check the List of 
Parties Excluded from Federal Procurement and Nonprocurement 
Programs.

[[Page 13642]]

    8. Nothing contained in the foregoing shall be construed to 
require establishment of a system of records in order to render in 
good faith the certification required by this clause. The knowledge 
and information of a participant is not required to exceed that 
which is normally possessed by a prudent person in the ordinary 
course of business dealings.
    9. Except for transactions authorized under paragraph 5 of these 
instructions, if a participant in a covered transaction knowingly 
enters into a lower tier covered transaction with a person who is 
proposed for debarment under 48 CFR part 9, subpart, 9.4, suspended, 
debarred, ineligible, or voluntarily excluded from participation in 
this transaction, in addition to other remedies available to the 
Federal Government, the department or agency with which this 
transaction originated may pursue available remedies, including 
suspension and/or debarment.
* * * * *

Certification Regarding Debarment, Suspension, Ineligibility and 
Voluntary Exclusion--Lower Tier Covered Transactions

    (1) The prospective lower tier participant certifies, by 
submission of this proposal, that neither it nor its principals is 
presently debarred, suspended, proposed for debarment, declared 
ineligible, or voluntarily excluded from participation in this 
transaction by any Federal department or agency.
    (2). Where the prospective lower tier participant is unable to 
certify to any of the statements in this certification, such 
prospective participant shall attach an explanation to this 
proposal.

Attachment E--Certification Regarding Environmental Tobacco Smoke

    Public law 103-227, Part C--Environmental Tobacco Smoke, also 
known as the Pro-Children Act of 1944 (Act), requires that smoking 
not be permitted in any portion of any indoor facility owned or 
leased or contracted for by an entity and used routinely or 
regularly for the provision of health, day care, education, or 
library services to children under the age of 18, if the services 
are funded by Federal programs either directly or through State or 
local governments, by Federal grant, contract, loan, or land 
guarantee. The law does not apply to children's services provided in 
private residences, facilities funded solely by Medicare or Medicaid 
funds, and portions of facilities used for inpatient drug or alcohol 
treatment. Failure to comply with the provisions of a civil monetary 
penalty of up to $1000 per day and/or the imposition of an 
administrative compliance order on the responsible entity.
    By signing and submitting this application the applicant/grantee 
certifies that it will comply with the requirements of the Act. The 
applicant/grantee further agrees that it will require the language 
of this certification be included in any subawards which contain 
provisions for children's services and that all subgrantees shall 
certify accordingly.

Attachment F (1 of 2)--Certification Regarding Lobbying

Certification for Contracts, Grants, Loans, and Cooperative Agreements

    The undersigned certifies, to the best of his or her knowledge 
and belief, that:
    (1) No Federal appropriated funds have been paid or will be 
paid, by or on behalf of the undersigned, to any person for 
influencing or attempting to influence an officer or employee of an 
agency, a Member of Congress, an officer or employee of Congress, or 
an employee of a Member of Congress in connection with the awarding 
of any Federal contract, the making of any Federal grant, the making 
of any Federal loan, the entering into of any cooperative agreement, 
and the extension, continuation, renewal, amendment, or modification 
of any Federal contract, grant, loan, or cooperative agreement.
    (2) If any funds other than Federal appropriated funds have been 
paid or will be paid to any person for influencing or attempting to 
influence an officer or employee of any agency, a Member of 
Congress, an officer or employee of Congress, or an employee of a 
Member of Congress in connection with this Federal contract, grant, 
loan, or cooperative agreement, the undersigned shall complete and 
submit Standard Form--LLL, ``Disclosure Form to Report Lobbying,'' 
in accordance with its instructions.
    (3) The undersigned shall require that the language of this 
certification be included in the award documents for all subawards 
at all tiers (including subcontracts, subgrants, and contracts under 
grants, loans, and cooperative agreements) and that all 
subrecipients shall certify and disclose accordingly.
    This certification is a material representation of fact upon 
which reliance was placed when this transaction was made or entered 
into. Submission of this certification is a prerequisite for making 
or entering into this transaction imposed by section 1352, title 31, 
U.S. Code. Any person who fails to file the required certification 
shall be subject to a civil penalty of not less than $10,000 and not 
more than $100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance

    The undersigned states, to the best of his or her knowledge and 
belief, that:
    If any funds have been paid or will be paid to any person for 
influencing or attempting to influence an officer or employee of any 
agency, a Member of Congress, an officer or employee of Congress, or 
an employee of a Member of Congress in connection with this 
commitment providing for the United States to insure or guarantee a 
loan, the undersigned shall complete and submit Standard Form--LLL, 
``Disclosure Form to Report Lobbying,'' in accordance with its 
instructions, Submission of this statement is a prerequisite for 
making or entering into this transaction imposed by section 1352, 
title 31, U.S. Code. Any person who fails to file the required 
statement shall be subject to a civil penalty of not less than 
$10,000 and not more than $100,000 for each such failure.

----------------------------------------------------------------------
Signature

----------------------------------------------------------------------
Title

----------------------------------------------------------------------
Organizaton

----------------------------------------------------------------------
Date

BILLING CODE 4184-01-M

[[Page 13643]]

[GRAPHIC] [TIFF OMITTED] TN21MR97.005



BILLING CODE 4184-01-C

[[Page 13644]]

ATTACHMENT G--Single Point of Contact List: September 1996

Arizona

Joni Saad, Arizona State Clearinghouse, 3800 N. Central Avenue, 
Fourteenth Floor, Phoenix, Arizona 85012, Telephone: (602) 280-1315, 
FAX: (602) 280-8144

Arkansas

Mr. Tracy L. Copeland, Manager, State Clearinghouse, Office of 
Intergovernmental Services, Department of Finance and 
Administration, 1515 W. 7th St., Room 412, Little Rock, Arkansas 
72203, Telephone: (501) 682-1074, FAX: (501) 682-5206

California

Grants Coordinator, Office of Planning & Research, 1400 Tenth 
Street, Room 121, Sacramento, California 95814, Telephone: (916) 
323-7480, FAX: (916) 323-3018

Delaware

Francine Booth, State Single Point of Contact, Executive Department, 
Thomas Collins Building, P.O. Box 1401, Dover, Delaware 19903, 
Telephone: (302) 739-3326, FAX: (302) 739-5661

District of Columbia

Charles Nichols, State Single Point of Contact, Office of Grants 
Mgmt. & Dev., 717 14th Street, NW.--Suite 500, Washington, DC 20005, 
Telephone: (202) 727-6554, FAX: (202) 727-1617

Florida

Florida State Clearinghouse, Department of Community Affairs, 2740 
Centerview Drive, Tallahassee, Florida 32399-2100, Telephone: (904) 
922-5438, FAX: (904) 487-2899

Georgia

Tom L. Reid, III, Administrator, Georgia State Clearinghouse, 254 
Washington Street, S.W.--Room 401J, Atlanta, Georgia 30334, 
Telephone: (404) 656-3855 or (404) 656-3829, FAX: (404) 656-7938

Illinois

Virginia Bova, State Single Point of Contact, Department of Commerce 
and Community Affairs, James R. Thompson Center, 100 West Randolph, 
Suite 3-400, Chicago, Illinois 60601, Telephone: (312) 814-6028, 
FAX: (312) 814-1800

Indiana

Amy Brewer, State Budget Agency, 212 State House, Indianapolis, 
Indiana 46204, Telephone: (317) 232-5619, FAX: (317) 233-3323

Iowa

Steven R. McCann, Division for Community Assistance, Iowa Department 
of Economic Development, 200 East Grand Avenue, Des Moines, Iowa 
50309, Telephone: (515) 242-4719, FAX: (515) 242-4859

Kentucky

Ronald W. Cook, Office of the Governor, Department of Local 
Government, 1024 Capitol Center Drive, Frankfort, Kentucky 40601-
8204, Telephone: (502) 573-2382, FAX: (502) 573-2512

Maine

Joyce Benson, State Planning Office, State House Station #38, 
Augusta, Main 04333, Telephone: (207) 287-3261, FAX: (207) 287-6489

Maryland

William G. Carroll, Manager, State Clearninghouse of 
Intergovernmental Assistance, Maryland Office of Planning, 301 W. 
Preston Street--Room 1104, Baltimore, Maryland 21201-2365, Staff 
Contact: Linda Janey, Telephone: (410) 225-4490, FAX: (410) 225-4480

Michigan

Richard Pfaff, Southeast Michigan Council of Governments, 1900 
Edison Plaza, 660 Plaza Drive, Detroit, Michigan 48226, Telephone: 
(313) 961-4226, FAX: (313) 961-4869

Mississippi

Cathy Mallette, Clearinghouse Officer, Department of Finance and 
Administration, 455 North Lamar Street, Jackson, Mississippi 39202-
3087, Telephone: (601) 359-6762, FAX: (601) 359-6764

Missouri

Lois Pohl, Federal Assistance Clearinghouse, Office of 
Administration, P.O. Box 809, Room 760, Truman Building, Jefferson 
City, Missouri 65102, Telephone: (314) 751-4834, FAX: (314) 751-7819

Nevada

Department of Administration, State Clearinghouse, Capitol Complex, 
Carson City, Nevada 89710, Telephone: (702) 687-4065, FAX: (702) 
687-3983

New Hampshire

Jeffrey H. Taylor, Director, New Hampshire Office of State Planning, 
Attn: Intergovernmental Review Process
Mike Blake, 2\1/2\ Beacon Street, Concord, New Hampshire 03301, 
Telephone: (603) 271-2155, FAX: (603) 271-1728

New Mexico

Robert Peters, State Budget Division, Room 190 Bataan Memorial 
Building, Sante Fe, New Mexico 87503, Telephone: (505) 827-3640

New York

New York State Clearinghouse, Division of the Budget, State Capitol, 
Albany, New York 12224, Telephone: (518) 474-1605

North Carolina

Chrys Baggett, Director, N.C. State Clearinghouse, Office of the 
Secretary of Admin., 116 West Jones Street, Raleigh, North Carolina 
27603-8003, Telephone: (919) 733-7232, FAX: (919) 733-9571

North Dakota

North Dakota Single Point of Contact, Office of Intergovernmental 
Assistance, 600 East Boulevard Avenue, Bismarck, North Dakota 58505-
0170, Telephone: (701) 224-2094, FAX: (701) 224-2308

Ohio

Larry Weaver, State Single Point of Contact, State Clearinghouse, 
Office of Budget and Management, 30 East Broad Street, 34th Floor, 
Columbus, Ohio 43266-0411
Please direct correspondence and questions about intergovernmental 
review to Linda Wise, Telephone (614) 466-0698, FAX: (614) 466-5400

Rhode Island

Daniel W. Varin, Associate Director, Department of Administration, 
Division of Planning, One Capitol Hill, 4th Floor, Providence, Rhode 
Island 02908-5870, Telephone: (401) 277-2656, FAX: (401) 277-2083
Please direct correspondence and questions to: Review Coordinator 
Office of Strategic Planning

South Carolina

Omeagia Burgess, State Single Point of Contact, Grant Services, 
Office of the Governor, 1205 Pendleton Street--Room 477, Columbia, 
South Carolina 29201, Telephone: (803) 734-0494, FAX: (803) 734-0385

Texas

Tom Adams, Governors Officer, Director, Intergovernmental 
Coordination, P.O. Box 12428, Austin, Texas 78711, Telephone: (512) 
463-1771, FAX: (512) 463-1888

Utah

Carolyn Wright, Utah State Clearinghouse, Office of Planning and 
Budget, Room 116 State Capitol, Salt Lake City, Utah 84114, 
Telephone: (801) 538-1535, FAX: (801) 538-1547

West Virginia

Fred Cutlip, Director, Community Development Division, W. Virginia 
Development Office, Building #6, Room 553, Charleston, West Virginia 
25305, Telephone: (304) 558-4010, FAX: (304) 558-3248

Wisconsin

Martha Kerner, Section Chief, State/Federal Relations, Wisconsin 
Department of Administration, 101 East Wilson Street--6th Floor, 
P.O. Box 7868, Madison, Wisconsin 53707, Telephone: (608) 266-2125, 
FAX: (608) 267-6931

Wyoming

Sheryl Jeffries, State Single Point of Contact, Office of the 
Governor, State Capital, Room 124, Cheyenne, Wyoming 82002, 
Telephone: (307) 777-5930, FAX: (307) 632-3909

Territories

Guam

Mr. Giovanni T. Sgambelluri, Director, Bureau of Budget and 
Management Research, Office of the Governor, P.O. Box 2950, Agana, 
Guam 96910, Telephone: 011-671-472-2285, FAX: 011-671-472-2825

Puerto Rico

Norma Burgos/Jose E. Caro, Chairwoman/Director, Puerto Rico Planning 
Board,

[[Page 13645]]

Federal Proposals Review Office, Minillas Government Center, P.O. 
Box 41119, San Juan, Puerto Rico 00940-1119, Telephone: (809) 727-
4444, (809) 723-6190, FAX: (809) 724-3270, (809) 724-3103

Northern Mariana Islands

Mr. Alvaro A. Santos, Executive Officer, State Single Point of 
Contact, Office of Management and Budget, Office of the Governor, 
Saipan, MP 96950, Telephone: (670) 664-2256, FAX: (670) 664-2272
Contact Person: Ms. Jacoba T. Seman, Federal Programs Coordinator, 
Telephone: (670) 644-2289, FAX: (670) 644-2272

Virgin Islands

Jose George, Director, Office of Management and Budget, #41 
Norregade Emancipation Garden Station, Second Floor, Saint Thomas, 
Virgin Islands 00802
Please direct all questions and correspondence about 
intergovernmental review to: Linda Clarke, Telephone: (809) 774-
0750, FAX: (809) 776-0069.

ATTACHMENT H--Department of Health and Human Services (DHHS), 
Regulations Applying to All Applicants/Grantees Under the Community 
Food and Nutrition Program

Title 45 of the Code of Federal Regulations:

Part 16--DHHS Grant Appeals Process
Part 74--Administration of Grants (non-governmental)
Part 74--Administration of Grants (state and local governments and 
Indian Tribal affiliates):

Sections
    74.26--Non-Federal Audits
    74.27--Allowable cost for hospitals and non-profit organizations 
among other things
    74.32--Real Property
    74.34--Equipment
    74.35--Supplies
    74.24--Program Income

Part 75--Informal Grant Appeal Procedures
Part 76--Debarment and Suspension from Eligibility for Financial 
Assistance

    Subpart F--Drug Free Workplace Requirements

Part 80--Non-discrimination Under Programs Receiving Federal 
Assistance through DHHS Effectuation of Title VI of the Civil Rights 
Act of 1964
Part 81--Practice and Procedures for Hearings Under Part 80 of this 
Title
Part 83--Regulation for the Administration and Enforcement of 
Sections 799A and 845 of the Public Health Service Act
Part 84--Non-discrimination on the Basis of Handicap in Programs and 
Activities Receiving Federal Financial Assistance
Part 85--Enforcement of Non-discrimination on the Basis of Handicap 
in Programs or Activities Conducted by DHHS
Part 86--Non-discrimination on the Basis of Sex in Education 
Programs and Activities Receiving or Benefitting from Federal 
Financial Assistance
Part 91--Non-discrimination on the Basis of Age in Health and Human 
Services Programs or Activities Receiving Federal Financial 
Assistance
Part 92--Uniform Administrative Requirements for Grants and 
Cooperative Agreements to States and Local Governments (Federal 
Register, March 11, 1988)
Part 93--New Restrictions on Lobbying
Part 100--Intergovernmental Review of DHHS Programs and Activities

[FR Doc. 97-7213 Filed 3-20-97; 8:45 am]
BILLING CODE 4184-01-M