Technical Operating Procedures 

for

STATE ACCESS 

under

The Oil Pollution Act of 1990 

U.S. COAST GUARD 

NATIONAL POLLUTION FUNDS CENTER 

NOVEMBER 1992 

Chapter 5 5-13 
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Chapter 5 5-14
Enclosure (1) to NPFCINST 16451.1 

U.S. Department Director 4200 Wilson Boulevard 

of United States Coast Guard Suite 1000 

Transportation National Pollution Funds Center 

Staff Symbol: (cp) 

United States Phone: (202) 493-6830 

Coast Guard 

NPFCINST 16451.1 

OCT 30 1992 

NATIONAL POLLUTION FUNDS CENTER INSTRUCTION 16451.1 

Subj: Technical Operating Procedures for State Access under Section 1012 (d) (1) of the 

Oil Pollution Act of 1990 (P.L. 101-380) 

1. PURPOSE. The enclosed Technical Operating Procedures (TOPs) are to be used by 

the National Pollution Funds Center (NPFC) to provide guidance to Federal OnScene Coordinators (FOSCs) and Coast Guard Districts concerning a State 

Governor’s request for access to the Oil Spill Liability Trust Fund (Fund) under 

section 1012 (d) (1) of the Oil Pollution Act of 1990 (OPA 90) (P.L. 101-380). These 

procedures have been developed to support the published interim rule (33 CFR 133) 

which accords the Governor of a State or the designated State official the opportunity 

to request funding for the immediate removal of a discharge, or the mitigation or 

prevention of a substantial threat of a discharge, of oil. 

2. DISCUSSION. 

a. The National Pollution Funds Center administers the Fund. The NPFC is 

responsible for developing regulations to implement section 1012 (d). 

b. The interim rule implements section 1012 (d) (1) of OPA 90 whereby the 

Governor of a State or a designated State official may request funding for 

removal costs concordant with the National Contingency Plan (NCP) not 

exceeding $250,000 per incident. At a later date, this interim rule may be 

incorporated into a Notice of Proposed Rulemaking covering all provisions of 

section 1012 (d). 

c. This TOPs is designed solely to facilitate the administration of the Fund by the 

NPFC. It should not be construed to confer any legal right or cause of action 

upon any party, nor to create any legal obligation on the NPFC. 

3. CHANGES. Changes to TOPs will be published by the NPFC for distribution to 

FOSCs, Coast Guard district offices, and other established users. Changes will be 

numbered consecutively. 

Chapter 5 5-15 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

NPFCINST 16451.1 

OCT 30 1992 

4. ACTION. The enclosed TOPs shall be used as guidance for any obligation of the 

Fund for State Access under section 1012 (d) (1). 

D. F. SHEEHAN 

Director

National Pollution Funds Center 

Encl: (1) Technical Operating Procedures for State Access under Section 1012 (d) (1) of 

the Oil Pollution Act of 1990 (P.L. 101-380) 

Distribution: COMDT (G-M) 

MLCLANT(f) 

MLCPAC(f) 

All CGD(m) 

FINCEN (OCD) 

Chapter 5 5-16 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

REQUEST FOR COMMENTS. 

The NPFC desires comments concerning these technical operating procedures. Please address 

comments to: 

Director (cp) 

U.S. Coast Guard 

National Pollution Funds Center 

4200 Wilson Blvd Ste 1000 

Arlington VA 22203-1804 

To submit comments on the regulations (33 CFR 133-State Access to OPA 90), follow the procedure 

specified in the Supplementary Information section of the preamble to 33 CFR 133. 

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RECORD OF CHANGES 

CHANGE 

NUMBER 

DATE OF 

CHANGE 

DATE 

ENTERED 

BY 

WHOM ENTERED 

CH-1 12 Feb 93 12 Feb 93 RH, CWO2 

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Chapter 5 5-20 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

STATE ACCESS TO OIL SPILL LIABILITY TRUST FUND 

TECHNICAL OPERATING PROCEDURES 

TABLE OF CONTENTS

REQUEST FOR COMMENTS.........................................................................................................5-17 

RECORD OF CHANGES .................................................................................................................5-19 

TABLE OF CONTENTS...................................................................................................................5-21 

PAGE 

1. INTRODUCTION........................................................................................................................ 5-23 

A. PURPOSE............................................................................................................................. 5-23 

B. SCOPE .............................................................................................................................. 5-23 

C. BACKGROUND.................................................................................................................. 5-23 

D. ADDITIONAL INFORMATION ....................................................................................... 5-24 

2. REQUESTING FUNDS............................................................................................................... 5-24 

A. ELIGIBILITY CONSIDERATIONS .................................................................................. 5-24 

B. COSTS INCURRED BEFORE FOSC CONTACT ........................................................... 5-24 

C. CONTACTING THE FOSC................................................................................................ 5-24 

D. EVALUATION BY FOSC .................................................................................................. 5-24 

E. OBLIGATION OF FUND AND ASSIGNMENT OF FPN/CEILING ............................. 5-25 

F. RAISING THE CEILING.................................................................................................... 5-25

G. OIL DISCHARGE REMOVAL AUTHORIZATION ....................................................... 5-25 

H. TERMINATION OF STATE ACCESS FUNDING .......................................................... 5-26 

3. DESIGNATION OF SOURCE & IDENTIFICATION OF RESPONSIBLE PARTIES.......... 5-26 

A. INVESTIGATION AND NOTIFICATIONS..................................................................... 5-26 

B. LETTER OF DESIGNATION ............................................................................................ 5-26 

4. REMOVAL COSTS..................................................................................................................... 5-26 

A. CONTRACT COSTS........................................................................................................... 5-26 

B. OUT OF POCKET EXPENSES.......................................................................................... 5-26 

C. STATE SALARY, EQUIPMENT, AND OVERHEAD COSTS ...................................... 5-26 

5. POLLUTION REPORTS (POLREPS)........................................................................................ 5-27 

A. POLREP CONTENTS......................................................................................................... 5-27 

B. POLREP FREQUENCY...................................................................................................... 5-27 

C. POLREP COMMUNICATION........................................................................................... 5-27 

6. RECORDKEEPING..................................................................................................................... 5-27 

A. DOCUMENTING COSTS-GENERAL.............................................................................. 5-27 

B. DOCUMENTING SALARY, EQUIPMENT, & ADMINISTRATION COSTS ............. 5-28 

C. INCIDENT REPORT........................................................................................................... 5-28 

Chapter 5 5-21 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

PAGE

7. REQUESTING PAYMENT ........................................................................................................ 5-29 

A. DISBURSEMENT VOUCHER ......................................................................................5-29

B. INCIDENT REPORT......................................................................................................5-29

C. REMOVAL COSTS........................................................................................................5-29

D. CERTIFICATIONS.........................................................................................................5-30

E. OVERALL CERTIFICATION .......................................................................................5-30

F. COPIES TO FOSC..........................................................................................................5-30 

G. TIMELINESS ...................................................................................................................5-30 

8. REVIEW OF DOCUMENTATION............................................................................................ 5-30 

9. PAYMENT PROCESS ................................................................................................................ 5-31 

10. COOPERATION IN COST RECOVERY/LITIGATION ......................................................... 5-31 

11. DOCUMENTATION AND THE FOSC..................................................................................... 5-31 

12. RELATIONSHIP TO COOPERATIVE AGREEMENT REQUIREMENTS .......................... 5-31 

A. REQUIRED FORMS/REPORTS........................................................................................ 5-31 

B. WAIVER OF CERTAIN FORMS/REPORTS ................................................................... 5-32 

C. FEDERAL AUDIT .............................................................................................................. 5-32 

13. NPFC POINT OF CONTACT..................................................................................................... 5-32 

Figure 1 STATE ACCESS FLOW CHART ..................................................................5-33 

Appendix A STATE OIL DISCHARGE REMOVAL AUTHORIZATION .......................5-35 

Appendix B CERTIFICATIONS .........................................................................................5-41 

Appendix C SF-LLL (Disclosure of Lobbying Activities) ..................................................5-48 

Appendix D SF-1080 (Voucher for Transfers Between Funds)...........................................5-52 

Chapter 5 5-22 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

TECHNICAL OPERATING PROCEDURES 

STATE ACCESS TO OIL SPILL LIABILITY TRUST FUND 

1. INTRODUCTION. Section 1012 (d) (1) of the Oil Pollution Act of 1990 (Public Law 101-

380, hereafter referred to as "OPA 90") provides that the President, upon request of the Governor of a 

State or his or her designated state official, may obligate the Oil Spill Liability Trust Fund (Fund) for 

payment in an amount not to exceed $250,000 per incident for removal costs consistent with the 

National Contingency Plan (NCP) (40 CFR 300). The removal costs must be required for the 

immediate removal of a discharge, or the mitigation or prevention of a substantial threat of discharge, 

of oil. Pursuant to the authority delegated to the Coast Guard in Executive Order 12777, the Coast 

Guard has published an interim regulation (33 CFR Part 133) to implement the provisions of section 

1012 (d) (1) of OPA 90. 

A. PURPOSE. The purpose of this document is to provide technical operating procedures 

concerning eligibility, communications, financial management, and recordkeeping for States 

requesting access to the Fund, Federal On-Scene Coordinators (FOSCs), and Coast Guard (USCG) 

District staffs. 

B. SCOPE. The technical operating procedures described herein apply specifically to 

requests for funding under section 1012 (d) (1) of OPA 90. Funding under section 1012 (d) (1) will 

herein be referred to as "State Access." These technical operating procedures focus on information 

that is needed to support cost recovery efforts of the Coast Guard National Pollution Funds Center 

(NPFC). Refer to Figure 1 for a flowchart of the State Access process. 

These procedures do not address the provisions of Section 1012 (d) (2) of OPA 90 (e.g., advance 

agreements with individual States, advance payments from the Fund, or access to the Fund by 

political subdivisions of a State). These procedures are intended as a supplement to, and not as a 

substitute for, the regulations contained in 33 CFR Part 133. Compliance with 33 CFR 133 is 

required whenever utilizing State Access to the Fund. Nothing in this document supersedes the 

requirements of the NCP. Of particular note, the designated state official, in accordance with 33 CFR 

133.5 (b) and section 300.320 (a) (6) of the NCP, assumes the responsibility for notifying the trustees 

of natural resources affected/potentially affected by the incident. 

C. BACKGROUND. State Access to the Fund provides a new avenue for States to receive 

Federal funds for immediate removal costs resulting from their response to actual or threatened 

discharges of oil. State Access does not supersede or preclude the use of existing Federal payment 

regimes. The State should not seek and will not receive payments for the same costs from more than 

one payment regime. Generally, there are two other payment regimes which the States may initiate to 

obtain Federal funding for oil spill incident removal actions: 

1. ACTING AS FOSC CONTRACTOR. State agencies may perform removal 

actions under the direct supervision of the FOSC. In these situations, the FOSC 

issues an Oil Spill Response Authorization to the State to establish a contractual 

relationship and obligate the Fund. With this method of funding the State is not 

limited to $250,000 per incident, and the FOSC is actively directing the State's 

response actions. 

2. CLAIMS. Section 1012 (a) (4) of OPA 90 authorizes use of the Fund for "the 

payment of claims in accordance with section 1013 for uncompensated removal costs 

determined by the President to be consistent with the National Contingency Plan or 

uncompensated damages". Regulations describing claims procedures are found in 33 

Chapter 5 5-23 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

CFR Part 136. States may submit claims for uncompensated removal costs, which 

may include those salaries, equipment, and administrative costs directly related to a 

specific incident. A State may submit claims for removal costs directly to the Fund 

even if the responsible party is known. Claims other than for removal costs must first 

be submitted to the designated responsible party. Claims payments are not limited to 

$250,000 per incident. 

D. ADDITIONAL INFORMATION. For additional information regarding these procedures 

or related subjects, State representatives, FOSCs, Coast Guard district staffs, and other interested 

parties are urged to contact the NPFC (see paragraph 13). 

2. REQUESTING FUNDS. 

A. ELIGIBILITY CONSIDERATIONS. Pursuant to 33 CFR 133.5, 133.7, and 133.13, the 

following will be evaluated by the FOSC when contacted by the State requesting funds under section 

1012 (d) (1): 

1. Is the incident eligible for immediate removal under the Clean Water Act, as 

amended by OPA 90? 

2. Is the substance discharged/threatening discharge oil? 

3. Did the incident occur after August 18, 1990? 

4. Is the aggregate amount of the request equal to or less than S250,000? 

5. Are the proposed actions consistent with the NCP (including 40 CFR 300.305 (c)'s 

requirement that a reasonable effort is made to have the discharger voluntarily and 

promptly perform removal actions)? 

6 . Are the proposed level of response, proposed actions, and amounts requested 

appropriate for the circumstances? 

7. Has the State the means to complete the immediate removal? 

B. COSTS INCURRED BEFORE FOSC CONTACT. Immediate removal costs involving a 

specific oil discharge incident which, due to exigent circumstances, were incurred by the State prior 

to the initial request to the FOSC for State Access, are allowable under State Access if the FOSC 

determines that: 1) notification is timely; 2) the response was consistent with the magnitude of the 

incident; and 3) costs incurred were otherwise reasonable under the circumstances and in all other 

respects were allowable. 

C. CONTACTING THE FOSC. In accordance with 33 CFR 133.9, the Governor or 

designated State official (henceforth referred to as the State official) shall request access to the Fund 

from the FOSC who is pre-designated for the area of the incident. The best method for contacting the 

FOSC is the telephone, because it allows for discussions and conference-calling. 

D. EVALUATION BY FOSC. Considering the NCP, 33 CFR 133.15, and the criteria in 

paragraph 2.A. above, the FOSC determines whether or not the proposed removal actions are eligible 

for funding. The FOSC may contact the NPFC case officer whenever questions arise. The decision 

by the FOSC is final. The FOSC may respond as follows: 

Chapter 5 5-24 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

1. If the FOSC concludes that the incident is not eligible for Federal removal under the 

NCP, that any of the criteria in paragraph 2.A. above are not met, or otherwise does not find State 

Access to be the appropriate removal mechanism for the incident, he/she will deny the request for 

State Access. The FOSC may conclude that the incident is eligible for removal under the NCP, but 

that a Federally led response is more appropriate to the situation. In this event, the FOSC may decide 

to utilize State resources through contract (see paragraph l.C.1.). Whenever a request for State Access 

is denied for any reason (including a decision for a Federally led response or a decision for no Federal 

response), the FOSC will, by the next business day following his/her decision, notify the NPFC Case 

Management Division (NPFC (cm)) and District (m) office, as appropriate, of the request and the 

specific reason(s) for denial. 

2. If the FOSC concludes that all of the criteria in paragraph 2.A. above are fulfilled and 

that State Access to the Fund is the best method to address the incident, he/she may then approve the 

request for State Access and contact the NPFC for assignment of a case-specific Federal Project 

Number (FPN) and a removal action funding ceiling (ceiling). The FOSC is responsible for ensuring 

that the State official is expeditiously informed of the FPN/ceiling. 

E. OBLIGATION OF THE FUND AND ASSIGNMENT OF THE FEDERAL PROJECT 

NUMBER AND FUNDING CEILING. 

1. The FOSC will pass the same information to the NPFC district representative that 

he/she would pass for other types of oil discharge responses when accessing the Fund through 

CANAPS. The FOSC identifies this as a State Access removal (in the comments block of CANAPS) 

which he/she has approved, requests assignment of an FPN/ceiling, and provides the name and 

telephonic/electronic/postal mail contact information of the requesting State official. With the 

issuance of an FPN/ceiling for the incident, the Coast Guard has obligated the Fund for payment. All 

further communications by all parties regarding the oil discharge incident should include the FPN and 

ceiling. 

2. The Fund is obligated for payment to the State and a cooperative agreement between 

the Coast Guard and the State is in effect when the NPFC assigns the FPN to this project. At this 

point the State may begin incurring costs against the FPN/ceiling. 

3. NPFC will access CANAPS to process the assignment of the FPN/ceiling. The 

message should include the NPFC, the FOSC, and the cognizant Regional Response Team (RRT) 

members as addressees, and should also be faxed to the cognizant State official. In addition to the 

information which is usually included in this type of notification, this message includes as a reference 

the telephone conference between the FOSC and the NPFC in which the FPN and ceiling were 

assigned, specifically notes that the funds were provided for State Access, and includes the 

telephonic, electronic, and mail contact information of the State official. 

F. RAISING THE CEILING. Requests for raising the amount of the FPN's ceiling are made 

to the cognizant FOSC. The procedure is identical to that outlined in subparagraphs 2.A-E. above. 

Requests for a higher ceiling shall not raise the overall ceiling above the $250,000/incident limit. 

G. OIL DISCHARGE REMOVAL AUTHORIZATION. An "Oil Discharge Removal 

Authorization" (see Appendix A) documents the cooperative agreement between the State and the 

Coast Guard. Upon issuance of the CANAPS message assigning the FPN/ceiling, the NPFC case 

officer forwards the Oil Discharge Removal Authorization and a certifications package (see 

Chapter 5 5-25 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

paragraph 7.D. below) to the State official. The State official should contact the NPFC case officer 

listed in the Authorization if any questions arise. 

H. TERMINATION OF STATE ACCESS FUNDING. If, at any time after approving a 

request for State Access, the FOSC determines that any of the criteria in paragraph 2.A. above were 

not/are no longer applicable to the immediate removal action, the FOSC may terminate State Access 

to the Fund. In this event, the State may receive payment for its allowable immediate removal costs 

that were incurred in good faith prior to the termination. While it is normally expected that the State 

official will notify the FOSC via POLREP (see paragraph 5 below) upon determination that the 

immediate removal is complete, the FOSC retains the authority to unilaterally declare completion of a 

Federal removal and terminate further Federal funding of the removal at any time the FOSC 

determines that immediate removal is complete. 

3. DESIGNATION OF SOURCE & IDENTIFICATION OF RESPONSIBLE PARTY. 

A. INVESTIGATION AND NOTIFICATIONS. In accordance with the Section 300.305 of 

the NCP and 33 CFR 133.23, the State shall promptly complete a thorough investigation to determine 

the source of discharge and to identify the responsible party(ies) (RP--normally, the owner or operator 

of the vessel or facility, including vehicles). The State should include this information in its 

POLREPs (see paragraph 5) and pass it directly to the NPFC case officer and FOSC via telephone as 

soon as it is known. 

B. LETTER OF DESIGNATION. Following receipt from the State of source and RP 

information, the NPFC case manager issues a Letter of Designation to the RP(s) to notify them of 

their designation as an RP and their responsibilities as an RP under Federal law. Also, the NPFC will 

send a copy of the Letter of Designation to the FOSC and State official. 

4. REMOVAL COSTS. Funds provided to the State under OPA 90 Section 1012 (d) (1) are for 

"immediate removal" of a discharge or substantial threat of a discharge. Pursuant to OPA 90 Sections 

1001(31) and 1012 (a) (1), and 33 CFR 133.13, allowable removal costs are all direct costs incurred 

to prevent, minimize, and mitigate oil pollution from the specific incident, including the costs of 

monitoring removal actions taken by the responsible party(ies) and the costs to prepare required 

documentation. State Access may only be used to pay for removal costs that are directly related to 

the specific incident. Costs must generally be incurred at the site or in support of on-site activities. 

State Access to the Fund is for immediate removal costs only, and will not be utilized for long-term 

removal or remediation costs, nor the costs of natural resource damage assessments. If questions 

arise, contact the NPFC case manager. Allowable costs include: 

A. CONTRACT COSTS. The State may be paid for contract costs incurred specifically for 

the removal action (e.g., cleanup contractor costs, waste disposal contractor costs, administrative 

contractor costs (for on-site cost documentation), etc. ). 

B. OUT OF POCKET EXPENSES. The State may also be paid for unbudgeted out-ofpocket State costs incurred specifically for the removal action, (e.g., OSHA and RCRA costs for the 

incident, travel to the site, consumable materials purchased specifically for the removal action, 

transportation or shipping costs for bringing materials to the site, equipment rentals, etc.). 

C. STATE SALARY, EQUIPMENT, AND OVERHEAD COSTS. The State may be paid 

for the salaries of personnel directly employed in the removal activities (including documenting those 

activities), the costs associated with the use of State equipment, and applicable overhead costs as may 

Chapter 5 5-26 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

be applied in accordance with OMB Circular A-87. Incorporating the State's predetermined standard 

rates for the period of use (usually hours or days) is the preferred method. 

5. POLLUTION REPORTS (POLREPs). The incident reporting requirements specified in 

300.315 of the NCP apply to the State official during immediate removals conducted under 33 CFR 

133. 

A. POLREP CONTENTS. Each POLREP must clearly describe the source, location, 

situation, actions taken, and future plans. The POLREP shall identify the responsible party, if known. 

The POLKEP should also note any potential damages incurred by third parties as a result of the 

incident which may give rise to claims under OPA 90. These may include private removal actions 

not funded through the Coast Guard; damages to natural resources or property (real or personal); loss 

of subsistence use of natural resources; loss of revenues by Federal, State, or local governments; loss 

of profits or earning capacity; and costs of State or local governments in providing increased or 

additional public services. The POLREP should cite the FPN and assigned ceiling and list the 

amount of obligations against that ceiling. 

B. POLREP FREQUENCY. POLREPs are sent as significant developments occur during 

response actions, and a final POLREP should be sent within 48 hours following the completion of 

immediate removal actions. It is envisioned that removal actions conducted under State Access will 

typically be of short duration, and the State may only need to file one POLREP (i.e., POLREP One 

and Final). 

C. POLREP COMMUNICATION. The State official shall submit POLREPs through 

communications networks or procedures established by the RRT. POLREPs are forwarded to the 

following: 

1. FOSC who authorized the State Access request; 

2. NPFC (cm); 

3. RRT; and 

4. Others as specified in area/local contingency plans. 

The POLREP should be delivered in writing by expeditious means (e.g., facsimile (fax), 

overnight mail, electronic mail, etc.) and may be provided by phone only when other expeditious 

means are unavailable. 

6. RECORDKEEPING. In accordance with 33 CFR Part 133.19 and Section 300.315 of the NCP, 

the State shall establish sufficient controls and procedures to provide documentation as follows: 

A. DOCUMENTING COSTS-GENERAL. The State should clearly identify the costs of 

immediate removal activities, the need for incurring those costs, the source of the spill, the identity of 

the responsible parties, and the facts which support those conclusions. 

1. WORK/PURCHASE WAS AUTHORIZED. Provide documentation that the work or 

purchase was authorized, (e.g., contracts, travel orders, purchase orders, work orders, rental contracts, 

etc.). The documentation should indicate why that activity was necessary and show the relationship 

to the removal actions at the specific site. A supervisor's certification is sufficient for State direct 

labor costs. 

Chapter 5 5-27 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

2. WORK/PURCHASE RECEIVED AND ACCEPTED. Provide documentation that the 

work or purchase was reviewed and accepted as complying with the authorization (e.g., receiving 

reports, delivery tickets with receipt signatures, ad hoc reports, etc.). 

3. BILLED FOR THE WORK. Provide documentation of the cost of the work or purchase 

and that the State was properly billed for those costs, (e.g., contractor's/vendor's invoice, cash register 

receipts, travel reimbursement vouchers, employee timesheets or logs, etc.). 

a. Work performed. The documentation should show the work performed - the service 

provided, the equipment used, the persons employed, etc. - and the quantity of each item of work 

performed each day (i.e., the delivered work product). Contractors performing work should prepare 

the documentation of the work performed. The State is responsible for ensuring the documentation of 

salary and equipment usage costs for the State. 

b. Work unit. The documentation should identify costs according to the unit of work 

for each item. For contracts, that unit of work is established by the contract line items (CLINs). For 

time and material based contracts, the unit of work is normally hours. The delivered work product for 

documentation purposes is, however, the number of units of the item provided per day (unless 

otherwise specified). For State employee salary costs, the unit is hours of work. For State equipment, 

the work unit is also typically hours, unless specific daily rates are established for that equipment. 

c. Cost of work. The documentation should show the cost of each unit of each item of 

work per day (or other time period set in the controlling agreement for that item) and the extended 

total cost. As discussed in paragraph 4.C., State salary and equipment usage costs should be 

determined using the State's standard rates. 

4. PAID FOR THE WORK. Provide documentation that the amount invoiced, shown 

on receipts, or presented on travel vouchers was paid or authorized for payment. State certification 

that the cost is authorized for payment and will be paid through normal State processes is sufficient 

for requesting payment from the Fund, provided that any later corrections or changes to the amount 

paid are promptly reported to the NPFC. 

B. DOCUMENTING SALARY, EQUIPMENT USAGE, AND ADMINISTRATIVE 

COSTS. State salary, equipment, and administrative costs are documented as follows for each day of 

removal activity: 

1. Date 

2. Identification (employee ID, equipment ID or description, function for removal 

action) 

3. Category (e.g., grade level, equipment type) 

4. Number of hours charged for that day 

5. Rate 

6. Total cost (hours times rate) 

7. Cumulative total for all days 

C. INCIDENT REPORT. The State official requesting Fund access should ensure that an 

Incident Report is submitted to the NPFC and the FOSC within 30 days after the completion of 

immediate removal activities. The Incident Report is a summary of the incident removal, and is used 

for recovery from the RP and various statistical purposes. The Incident Report should describe the 

incident and list parties of interest. The Incident Report should also include copies of any related 

State reports, violation reports, etc., available at the time. The Incident Report may be included as 

Chapter 5 5-28 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

part of a POLREP, provided that the Incident Report portion is specifically identified and all 

necessary information is presented. 

1. INCIDENT DESCRIPTION. The Incident Report includes the following: 

a. Report Date 

b. Federal Project Number and Ceiling 

c. Name and address of State agency submitting report and name of FOSC 

d. Name and phone number of contact person 

e. Date of incident 

f. Dates and times removal actions began and ended 

g. Location of incident 

h. Material involved 

i. Quantity discharged 

j. Nature of substantial threat if no discharge 

k. Body of water affected 

1. Ambient conditions which may affect removal 

m. Source of discharge or substantial threat 

n. Short description of the incident and removal activities (if not adequately 

described in POLREPS) 

o. Short description of damage to any potential natural resource or other damages 

due to the incident 

2. PARTIES OF INTEREST. In addition to the information describing the incident, the 

Incident Report should include information identifying all parties of interest (e.g., State participants in 

the removal activities, the responsible parties, witnesses) as follows: 

a. Names and addresses of responsible parties, owners and operators of vessels 

or facilities 

b. Names, identification numbers, and phone numbers of State employees 

involved in the removal activities 

c. Names, addresses, and phone numbers of local municipality participants, 

(e.g., fire department employees, local police) 

d. Names, addresses, and phone numbers of any witnesses 

7. REQUESTING PAYMENT. The State should forward the documents listed in subparagraphs 

A.-D. below to NPFC (cm). The State will receive payment for allowable immediate removal costs 

after the documentation has been received and reviewed favorably by the NPFC. 

A. DISBURSEMENT VOUCHER. The State requests payment using either 1) SF-1080 (see 

Appendix D), Voucher for Transfers Between Appropriations and/or Funds (preferred), 2) SF 270, 

Request for Advance or Reimbursement, or 3) an equivalent State invoice acceptable to the NPFC. 

B. INCIDENT REPORT (See paragraph 6.C. above). Submitting a properly-documented 

request for a partial payment is encouraged if preparing the submission of a request for full payment 

would delay the NPFC's receipt of the Incident Report longer than 30 days beyond the completion of 

the immediate removal. 

C. REMOVAL COSTS (See paragraph 4). 

Chapter 5 5-29 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

D. CERTIFICATIONS. Certain certifications (see Appendix B) involving cooperative 

agreements between Federal and State agencies are required by 49 CFR Parts 18, 20, and 29 (see 

paragraph 12.A. below for a complete description). Accordingly, the State official shall ensure 

compliance with, sign, and return the following certifications: 

1. Certification Regarding Lobbying. 

2. Certification Regarding Debarment, Suspension, and Other Responsibility Matters. 

a. The certification for Primary Covered Transactions is required from the State 

itself. 

b. The certifications for Lower Tier Covered Transactions shall be submitted by 

the State on behalf of each of its contractors. 

3. Certification Regarding Drug-Free Workplace Requirements. 

a. Required from the State to certify its employees. If, in accordance with 49 CFR 

29.630 (c), the State has a current blanket Drug-Free Workplace certification, 

the State official may forward a copy of it in lieu of signing an incident-specific 

certification. 

E. OVERALL CERTIFICATION. By the act of submitting the request for payment, the 

State official is certifying that costs incurred were consistent with the advance approval by the FOSC, 

that costs were directly related to removal actions for the specific incident, and that the State will pay 

or has paid the amounts presented. 

F. COPIES TO FOSC. The State shall submit a copy of the Incident Report and cost 

documentation (see paragraphs 7.B.-C. above) to the cognizant FOSC. 

G. TIMELINESS. In accordance with 33 CFR 133.19 (b), the request for payment, Incident 

Report, cost documentation, and certifications described in paragraphs VII.A-D. above should reach 

the NPFC no later than 30 days after the completion of immediate removal actions. In the event that 

certain documentation is unavailable or delayed, the State should submit that portion of the 

documentation that is available and forward a supplemental request for payment as the additional 

records become available. This information is needed rapidly to allow the NPFC to expeditiously pay 

the State and seek reimbursement from responsible parties. In accordance with 49 CFR 18.41 (b) (4), 

the NPFC may deobligate the Fund for payment if all required documentation is not received by the 

NPFC and found to be complete and satisfactory within 90 days following completion of an 

immediate removal action. The State is ineligible for payment under 33 CFR 133 following 

deobligation of the Fund. 

8. REVIEW OF DOCUMENTATION. Upon receipt of the documents in paragraphs 7.A.-D. 

above, the NPFC will review them for completeness and to ensure that all removal costs are eligible 

for payment. If the documentation is not complete, the NPFC will promptly notify the State of what 

information is missing. If the NPFC determines that there are costs of an operational nature which 

may be ineligible for payment, the NPFC will confer with the cognizant FOSC. If the NPFC 

concludes that certain removal costs are ineligible for payment, it will delete those costs from the 

payment request made to the USCG Finance Center, and will promptly send a report of the 

disallowed costs to the State and to the FOSC. If, 90 days following the completion of the immediate 

removal, the State has failed to submit documentation to the NPFC which the NPFC finds to be 

complete and satisfactory, the NPFC may deobligate the Fund for payment of any removal costs 

which remain unsubstantiated. 

Chapter 5 5-30 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

9. PAYMENT PROCESS. After the State documents are reviewed and found to be complete and 

satisfactory, the NPFC Case Manager authorizes payment and the NPFC Financial Manager promptly 

processes the payment request through the USCG Finance Center. 

10. COOPERATION IN COST RECOVERY/LITIGATION. By requesting State Access to the 

Fund, the State agrees to cooperate fully in any cost recovery actions and/or litigation to enforce the 

provisions of OPA 90. 

11. DOCUMENTATION AND THE FOSC. Copies of the FPN/ceiling authorization, Oil 

Discharge Removal Authorization, Incident Report, cost documentation, and report of disallowed 

costs are sent to the FOSC for informational purposes only. The FOSC is not obligated to review or 

retain these documents. 

12. RELATIONSHIP TO COOPERATIVE AGREEMENT REQUIREMENTS. As described in 

33 CFR 133.5 (c), the Federal Grant and Cooperative Agreement Act of 1977 (31 USC 6301-6308) 

and 49 CFR Parts 18, 20, 29, and 90 apply to Fund monies obligated for payment under the State 

Access provisions of Section 1012 (d) (1) of the Oil Pollution Act. While compliance with these laws 

and regulations requires the submission of certain forms/reports from the State to the Federal 

government, some of the forms/reports have been waived because the nature of immediate removal 

actions obviates the need them. 

A. REQUIRED FORMS/REPORTS. (refer to procedures throughout this document for a 

complete description of all forms/reports required under State Access). The following forms/reports 

are required by 49 CFR 18, 20, and 29, have not been waived, and should be submitted concurrently 

with the Incident Report and cost documentation: 

1. SF 270, Request for Advance or Reimbursement 

This form or the optional/preferred SF 1080 (Voucher for Transfers Between 

Appropriations) or a State invoice acceptable to the NPFC is used by States to 

request payment from the Fund. 

2. Certification Regarding Lobbying 

(See paragraph 7.D.1.) Required by 49 CFR 20. A copy of this certification is 

included in the certifications package provided by the NPFC to the State. 

3. Certification Regarding Debarment, Suspension, and other Responsibility Matters 

(See paragraph 7.D.2.) Required by 49 CFR 29. A copy of this certification is 

included in the certifications package provided by the NPFC to the State. The 

cooperative agreement between the State and the Coast Guard is a primary covered 

transaction. A contract between the State and a private contractor is a lower-tier 

covered transaction. 

4. Certification Regarding Drug-Free Workplace Requirements 

(See paragraph 7.D.3) Required by 49 CFR 29. A copy of this certification is 

included in the certifications package provided by the NPFC to the State (see 

paragraph 7.D.3.a. for blanket certification exception). 

Chapter 5 5-31 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

B. WAIVER OF CERTAIN FORMS/REPORTS. The requirements in 49 CFR Parts 18, 20, 

and 29 regarding the following specific forms and reports are waived as follows for State Access 

under 1012 (d) (1) of the Oil Pollution Act: 

1. SF 424, Application for Federal Assistance 

The requirement for use of this form is waived. The request made by the Governor 

or his/her designated representative to the FOSC for access to the Fund suffices as an 

application. 

2. SF 272, Federal Cash Transactions Report 

This form is not required since, under OPA 90 Sect. 1012 (d) (1), the Fund only pays 

States for costs already incurred. 

3. SF 424A, Budget Information - Non-construction Programs 

This form is not required since, under OPA 90 Sect. 1012 (d) (1), the Fund only pays 

States for those costs already incurred, and each incident represents a separate 

agreement between the State and the Fund. 

4. SF 424C, Budget Information - Construction Programs 

This form is not required because removal actions are not considered construction 

programs. 

5. SF 269A, Financial Status Report 

The requirement for this report is waived. The State's request for payment that is 

submitted with the Incident Report and accompanying cost documentation meets all 

financial reporting requirements. it is envisioned that each incident would be 

completed in substantially less than three months. 

6. Nonconstruction performance reports 

The requirement for this report is waived. Performance information available from 

subsequent applications contains sufficient information to meet programmatic needs. 

C. FEDERAL AUDIT. In accordance with 49 CFR 90, acceptance of Federal funds through 

a cooperative agreement may make the State subject to an annual or biennial Statewide Federal audit 

of all of its grants and cooperative agreements with the Federal government. 

13. NPFC POINT OF CONTACT. The NPFC case management officer can be contacted as 

follows: 

Director (cm)

U.S. Coast Guard 

National Pollution Funds Center 

4200 Wilson Blvd Ste 1000 Tel. (202) 493-6732 

Arlington VA 22203-1804 Fax. (202) 493-6896 

Chapter 5 5-32 ORIGINAL 
Enclosure (1) to NPFCINST 16451.1 

FLOW 

State Access to OSLTF Under Secretary. 1012(d)(1) of OPA 90

State official requests 

Initial Fund access (or ceiling 

increase) from cognizant EPA 

or USCG FOSC

FOSC evaluates

request

NPFC mails oil discharge 

removal authorization and 

certifications package to State 

(and copy to FOSC)

FOSC denies 

request

FOSC 

electronically 

notifies NPFC 

(cm) and USCG 

District (m) of 

denial (next 

business day)

FOSC obtains 

FPN/ceiling 

via CANAPS

State submits source & 

Representative investigation 

results to NPFC and FOSC

NPFC issues Letter(s) of 

Designation to Representative(s)

State submits POLREPS to 

designated addresses as 

necessary & upon completion 

of immediate removal

tate submits to ...

Incident Report Cost 

documentation

RDL/DS/DFW* certs SF 

1080 or SF-2701

FOSC NPFC†

NPFC reviews State document

Document

Complete?

All removal costs 

allowable?

NPFC may withhold 

payment & requests 

needed documents 

from State†

NPFC confers with 

FOSC if costs are of 

operational nature

NPFC submits payment 

request to USCG FinCen

NPFC deletes 

disallowed costs

NPFC forwards 

report to State (& 

copy to FOSC)

USCG FinCen 

makes payment 

to State

No

No

Allowed

Yes

Yes

costs

FOSC ensures 

FPN/ceiling (or ceiling 

increase is passed to State 

official & the NPFC

†NPFC may deobligate Fund if all 

documentation is not received by 

NPFC within 90 days following 

completion of immediate removal. 

*RQL – restrictions on lobbying 

DS – Department/Suspension 

DFW – Drug Free Workplace

S 

 

Chapter 5 5-33 
Chapter 5 5-34

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 APPENDIX A ORIGINAL

5-35

 

STATE OIL DISCHARGE REMOVAL AUTHORIZATION 

FOR 

THE OIL POLLUTION ACT OF 1990 

(PUBLIC LAW 101-380) 
 

 APPENDIX A ORIGINAL

5-36

This Page Intentionally Left Blank
Chapter 5 Page 1 of 3 

 APPENDIX A ORIGINAL

5-37

STATE OIL DISCHARGE REMOVAL AUTHORIZATION 

Recipient State: ___________________________________________________________________ 

Address: ________________________________________________________________________ 

 ________________________________________________________________________ 

 ________________________________________________________________________ 

1. Purpose

 This document obligates the Oil Spill Liability Trust Fund (Fund) for payment to the Recipient 

State for certain removal costs incurred in response to the following pollution incident: 

___________________________________, FPN #________________________________________. 

This funding authorization is contingent upon the Recipient's compliance with the requirements 

contained herein, the National Contingency Plan (40 CFR Part 300), 33 CFR Part 133, and 49 CFR 

Parts 18, 20, 29, and 90. 

2. Approved Functions and Pay Limit

 Payment will be made only for actions that are consistent with the initial authorization or 

approved in advance by the FOSC. Approval may be verbal or written. Assessment, restoration, 

rehabilitation, or replacement of Natural Resources damaged by the spill are not covered. 

 Maximum limit of authorization: $ ____________________________________. 

3. Conditions

 See attached page(s) for special conditions, dates of performance, direction, or approvals. 

4. Period of Authorization

 This authorization shall remain in effect until the designated State official notifies the FOSC and 

NPFC that the immediate removal has been completed or the FOSC terminates Federal funding of the 

immediate removal. 

5. Payment Procedure

 The Recipient State will submit the required documents in accordance with 33 CFR Part 133 upon 

completion of removal activities. 

 The Coast Guard may deobligate the Fund for payment of any costs for which proper 

documentation has not been received within 90 days following the date of the completion of the 

immediate removal. 
Chapter 5 Page 2 of 3 

 APPENDIX A ORIGINAL

5-38

STATE OIL DISCHARGE REMOVAL AUTHORIZATION 

6. Hold Harmless and Indemnify

 By performing any action or seeking any reimbursement under this funding authorization, the 

Recipient State agrees to indemnify and hold harmless the United States of America, and all of its 

departments and agencies, including without limitation the U.S. Coast Guard and the Oil Spill Liability 

Trust Fund ("United States"), with respect to any and all suits, actions and claims, of whatever kind or 

nature, arising from or relating to the Recipient’s; actions, omissions, or other involvement in this spill. 

Recipient State further agrees to waive any rights of action and/or claims which it may have against the 

United States arising from or relating to its actions, omissions, or other involvement in this spill. 

7. No Agency

 Nothing in this funding authorization is intended to create an agency relationship between the 

Recipient State and the United States of America (or any of its departments, agencies, or employees). 

Nor shall anything in this funding authorization be construed as creating an agency relationship. By 

performing any action or seeking any reimbursement under this funding authorization, the Recipient 

State agrees that it has not been authorized to act as an agent of the United States, and shall not act in 

any such capacity. 

B. Accounting Data

 Document Control Number: ___________________________________________________ 

9. Points of Contact

 A. __________________Tel ( ) __________________Fax ( ) ___________________ 

FOSC 

 B. __________________Tel ( ) __________________Fax ( ) ___________________ 

 Recipient State Representative 

 C. __________________Tel ( ) __________________Fax ( ) ___________________ 

 NPFC Case Officer 

10. Authorizing Official

 Signature: ________________________________________________________________ 

 Title: _______________________________________ Date: _______________________ 

Attachments: No __________ Yes __________ 
Chapter 5 Page 3 of 3 

 APPENDIX A ORIGINAL

5-39

AMENDMENT TO 

STATE OIL DISCHARGE REMOVAL AUTHORIZATION 

Issued to (Recipient State):________________________________________________________ 

By (NPFC Case Officer): _________________________________________________________ 

Date of Original Authorization: ____________________________________________________ 

FPN # of Original Authorization: ___________________________________________________ 

The Authorization cited above is amended as follows: 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

Document Control Number (if applicable): ___________________________________________ 

Authorizing Official 

 Signature: _______________________________________________________________ 

 Title: ________________________________________Date: ________________

 
 

 5-40

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Chapter 5 

 5-41

CERTIFICATIONS 

FOR 

CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
Chapter 5 

 5-42

This Page Intentionally Left Blank
Enclosure (1) to NPFCINST 16451.1 

Chapter 5 Page 1 of 5 

 APPENDIX A ORIGINAL

5-43

APPENDIX A TO PART 49 CFR 20 

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.” (See Appendix C) 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 

$100,00 for each such failure. 

SIGNATURE _________________________________________ 

TITLE _______________________________________________ 

FPN# ____________________________ Return signed originals to: 

 National Pollution Funds Center (cm) 

 4200 Wilson Blvd. 

 Arlington, VA 2203-1804 
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 Page 2 of 5 5-44

APPENDIX A TO PART 29 

CERTIFICATION REGARDING DEPARTMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS 

PRIMARY COVERED TRANSACTION 

Instructions for Certification

 1. By signing and submitting this proposal, the prospective primary participant 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 or agency's determination whether to enter into this 

transaction. However. failure of the prospective primary participant 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 of default. 

 4. The prospective primary participant shall provide immediate written notice to the department or agency to whom 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 into any lower tier covered transaction with a person who is debarred, suspended. declared ineligible, or 

voluntarily excluded from participation into 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 solicitation 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 debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, 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 Nonprocurement List (Tel. (202) 366-4268). 

 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 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 from covered transactions 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: 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. 

SIGNATURE _________________________________ FPN # _____________________ 

TITLE _______________________________________ 
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 Page 3 of 5 

 APPENDIX B ORIGINAL 

5-45

APPENDIX B to 49 CFR PART 29 

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 in 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 has 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 meanings set out in the Definition 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, should the proposed covered transaction be 

entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared 

ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by 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 debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, 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 Nonprocurement List (Tel. (202) 366-4268). 

 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 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 

Transactions Lower Tier Covered

 (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 included 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. 

SIGNATURE _____________________________________ 

TITLE ___________________________________________ 

FPN # ____________________ 
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 Page 4 of 5 

 APPENDIX C ORIGINAL 

5-46

APPENDIX C TO 49 CFR PART 29 

CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

Instructions for Certification

 1. By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below.

 2. The certification set out below is a material representation of fact upon which reliance is placed when the agency awards the grant. If it is 

later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the agency, in 

addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act. 

 3. For grantees other than individuals, Alternate I applies. 

 4. For grantees who are individuals, Alternate II applies. 

 5. Workplace under grants, for grantees other than individuals. need not be identified on the certification. If known, they may be identified in 

the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep 

the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces 

constitutes a violation of the grantee's drug-free workplace requirements. 

 6. Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work under the grant takes 

place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in operation. State employees in 

each local unemployment office, performers in concert halls or radio studios). 

 7. If the workplace identified to the agency changes during the performance of the grant,.the grantee shall inform the agency of the change(s), if 

it previously identified the 

workplaces in question (see paragraph five). 

 8. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply to this 

certification. Grantees' attention is called, in particular, to the following definitions from these rules: 

 Controlled substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and as further defined 

by regulation (21 CFR 1308.11 through 1308.15): 

Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the 

responsibility to determine violations of the Federal or State criminal drug statutes: 

 Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession of any

controlled substance: 

Employee means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) All direct charge employees: (ii) All 

indirect charge employees unless their impact or involvement is insignificant to the performance of the grant: and, (iii) Temporary personnel and consultants 

who are directly engaged in the performance of work under the grant and who are on the grantee’s payroll. This definition does not include workers not on the 

payroll of the grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or independent contractors not on the grantee's payroll; or 

employees of subrecipients or subcontractors in covered workplaces). 

Certification Regarding Drug-Free Workplace Requirements

Alternate I. (Grantees Other Than Individuals) 

 A. The grantee certifies that it will or will continue to provide a drug-free workplace by: 

 (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled 

substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such prohibition; 

 (b) Establishing an ongoing drug-free awareness program to inform employees about-- 

 (1) The dangers of drug abuse in the workplace; 

 (2) The grantee’s policy of maintaining a drug-free workplace; 

 (3) Any available drug counseling, rehabilitation, and employee assistance programs; and 

 (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; 

 (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by 

paragraph (a); 

 (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will-- 

 (1) Abide by the terms of the statement; and 

 (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five 

calendar days after such conviction; 

 (e) Notifying the agency in writing, within ten calendar days after receiving notice under paragraph (d) (2) from an employee or otherwise 

receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other 

designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. 

Notice shall include the identification number(s) of each affected grant; 

 (f) Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d) (2), with respect to any employee who is 

so convicted-- 

 (1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the 

Rehabilitation Act of 1973, as amended; or 

 (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, 

State, or local health, law enforcement, or other appropriate agency: 

 (g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f). 

 B. The grantee may insert in the space provided below the sites(s) for the performance of work done in connection with the specific grant: 

Place of Performance (Street address, city, county, state, zip code) 

Check if there are workplaces on file that are not identified here. 

SIGNATURE _________________________________ FPN # ______________________ 

TITLE _______________________________________
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 Page 5 of 5 

 APPENDIX C ORIGINAL 

5-47

APPENDIX C TO 49 CFR PART 29 

CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

Instructions for Certification

 1. By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below.

 2. The certification set out below is a material representation of fact upon which reliance is placed when the agency awards the 

grant. If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the DrugFree Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized under 

the Drug-Free Workplace Act. 

 3. For grantees other than individuals, Alternate I applies. 

 4. For grantees who are individuals, Alternate II applies. 

 5. Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If known, they may 

be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no 

application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal 

inspection. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements. 

 6. Workplace identification must include the actual address of buildings (or parts of buildings) or other sites where work under 

the grant takes place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while 

in operation, State employees in each local unemployment office, performers in concert halls or radio studios). 

 7. If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of 

the change(s), if it previously identified the workplaces in question (see paragraph five). 

 8. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace common 

rule apply to this certification. Grantees' attention is called, in particular, to the following definitions from these rules:

 Controlled substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and 

as further defined by regulation (21 CFR 1308.11 through 1308.15): 

 Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body 

charged with the responsibility to determine violations of the Federal or State criminal drug statutes: 

 Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or 

possession of any controlled substance; 

 Employee means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) All direct 

charge employees: (ii) All indirect charge employees unless their impact or involvement is insignificant to the performance of the grant; 

and, (iii) Temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the 

grantee’s payroll. This definition does not include workers not On the payroll of the grantee (e.g,. volunteers, even if used to meet a 

matching requirement; consultants or independent contractors not on the grantee's payroll; or employees of subrecipients or subcontractors 

in covered workplaces). 

Certification Regarding Drug-Free Workplace Requirements

Alternate II. (Grantees Who Are Individuals) 

 (a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, 

dispensing, possession, or use of a controlled substance in conducting any activity with the grant: 

 (b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or 

she will report the conviction, in writing, within 10 calendar days of the conviction, to every grant officer or other designee, unless the 

Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the 

identification number(s) of each affected grant. 

SIGNATURE _________________________________ 

TITLE _______________________________________ 

FPN # _____________________
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 

 APPENDIX C 

5-48

 DISCLOSURE OF LOBBYING ACTIVITIES 

Approved by OMB 

 0345-0046 

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 

(See reverse for public burden disclosure.) 

1. Type of Federal Action: 

 a. contract 

 b. grant 

 c. cooperative agreement 

 d. loan 

 e. loan guarantee 

 f. loan insurance 

2. Status of Federal Action: 

 a. bid/offer/application 

 b. initial award 

 c. post-award 

3. Report Type: 

 a. initial filing 

 b. material change 

 For Material Change Only: 

 year ______ quarter ______ 

 date of last report ________ 

4. Name and Address of Reporting Entity: 

 Prime Subawardee 

 Tier _____, if known: 

 Congressional District, if known: 

5. If Reporting Entity is No. 4 in Subawardee, Enter Name and 

 Address of Prime:

 Congressional District, if known: 

6. Federal Department/Agency: 7. Federal Program Name/Description: 

 CFDA Number, if applicable: ___________________ 

8. Federal Action Number, if known: 9. Award Amount, if known:

 $ 

10. a. Name and Address of Lobbying Entity

 (if individual, last name, first name, MI):

b. Individuals Performing Services (including address if different 

 from No. 10a)

 (last name, first name, MI): 

(attach Continuation Sheet(s) SF-LLL-A, if necessary) 

11. Amount of Payment (check all that apply): 

 $ ______________ actual planned

13. Type of Payment (check all that apply):

 a. retainer 

 b. one-time fee 

12. Form of Payment (check all that apply):

 a. cash 

 b. in-kind; specify: nature ________________ 

 value ________________ 

 c. commission 

 d. contingent fee 

 e. deferred 

 f. other, specify: ________________ 

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) 

contacted, for Payment Indicated in Item 11: 

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

15. Continuation Sheet(s) SF-LLL-A attached: Yes No 

16. Information requested through this form is authorized by title 31 

U.S.C. section 1352. This disclosure of lobbying activities is a 

material representation of fact upon which NPFC was placed by 

the tier above when this transaction was made or entered into. 

This disclosure is requested pursuant to 31 U.S.C. 1352. This 

information will be reported to the Congress semi-annually and 

will be available for public inspection. Any person who fails to 

file the requested disclosure shall be subject to a civil penalty of 

not less than $10,000 and nor more than $100,000 for each such 

failure. 

Signature: ______________________________________ 

Print Name: ______________________________________ 

Title: ___________________________________________ 

Telephone No.: _________________ Date: _____________ 

Authorized for Local Reproduction 

Standard Form - LLL
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 

 APPENDIX C 

5-49

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES 

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal 

recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous 

filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or 

agreement to make payment to any lobbying entity for influencing or attempting to influence an 

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

employee of a Member of Congress in connection with a covered Federal action. Use the SF-LLL-A 

Continuation Sheet for additional information if the space on the form is inadequate. Complete all 

items that apply for both the initial filing and material change report. Refer to the implementing 

guidance published by the Office of Management and Budget for additional information. 

 1. Identify the type of covered Federal action for which lobbying activity is and/or has been 

secured to influence the outcome of a covered Federal action. 

 2. Identify the status of the covered Federal action. 

 3. Identify the appropriate classification of this report. If this is a followup report caused by 

a material change to the information previously reported, enter the year and quarter in 

which the change occurred. Enter the date of the last previously submitted report by this 

reporting entity for this covered Federal action. 

 4. Enter the full name, address, city, state and zip code of the reporting entity. Include 

Congressional District, if known. Check the appropriate classification of the reporting 

entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the 

tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards 

include but are not limited to subcontracts, subgrants and contract awards under grants. 

 5. If the organization filing the report in Item 4 checks “Subawardee”, then enter the full 

name, address, city, state and zip code of the prime Federal recipient. Include 

Congressional District, if known. 

 6. Enter the name of the Federal agency making the award or loan commitment. Include at 

least one organizational level below agency name, if known. For example, Department of 

Transportation, United States Coast Guard. 

 7. Enter the Federal program name or description for the covered Federal action (item 1). If 

known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, 

cooperative agreements, loans, and loan commitments. 

 8. Enter the most appropriate Federal identifying number available for the Federal action 

identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) 

number; grant announcement number; the contract, grant, or loan award number; the 

application/proposal control number; the application/proposal control number assigned by 

the Federal agency). Include prefixes, e.g., “RFP-DE-90-001.” 

 9. For a covered Federal action where there has been an award or loan commitment by the 

Federal agency, enter the Federal amount of the award/loan commitment for the prime 

entity identified in Item 4 or 5. 

10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged 

by the reporting entity identified in item 4 to influence the covered Federal action. 
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 

 APPENDIX C 

5-50

(b) Enter the full names of the individual(s) performing services, and include full address if 

different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI). 

 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting 

entity (Item 4) to the lobbying entity (Item 10). Indicate whether the payment has been 

made (actual) or will be made (planned). Check all boxes that apply. If this is a material 

change report, enter the cumulative amount of payment made or planned to be made. 

 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through 

an in-kind contribution, specify he nature and value of the in-kind payment. 

 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 

 14. Provide a specific and detailed description of the services that the lobbyist has performed, 

or will be expected to perform, and the date(s) of any services rendered. Include all 

preparatory and relative activity, not just time spent in actual contact with Federal 

officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), 

employee(s), or Member(s) of Congress that were contacted. 

 15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached. 

 16. The certifying official shall sign and date the form, print his/her name, title, and telephone 

number. 

Public reporting burden for this collection of information is estimated to average 30 minimum 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 (03-48-0046), Washington, D.C. 20503. 
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 

 APPENDIX D 

5-51

 DISCLOSURE OF LOBBYING ACTIVITIES Approved by 

OMB 

 CONTINUATION SHEET 0348-0046 

Reporting Entity: ___________________________________________ Page ______ of ______ 

 Authorized for Local Reproduction 
 Enclosure (1) to NPFCINST 16451.1 

Chapter 5 

 APPENDIX D 

5-52

Standard Form 1080 

Revised April 1982 

Department of the Treasury 

FRM 2-2500 

1080-109 

VOUCHER FOR TRANSFERS 

BETWEEN APPROPRIATIONS AND/OR FUNDS

VOUCHER NO. 

SCHEDULE NO. 

Department, establishment, bureau, or office receiving funds 

BILL NO. 

Department, establishment, bureau, or office charged 

 Director (CM) 

 United States Coast Guard 

 National Pollution funds Center 

 4200 Wilson Blvd. 

 Suite 1000 

 Arlington, VA 22203-1804 

PAID BY 

 DATE OF QUAN- UNIT PRICE AMOUNT 

ORDER NO. DELIVERY ARTICLE OR SERVICES TITY COST PER DOLLARS AND CENTS 

 

 TOTAL 

Remittance in payment hereof should be sent to

ACCOUNTING CLASSIFICATION Office Receiving Funds

CERTIFICATE OF OFFICE CHARGED 

 I certify that the above articles ere received and accepted or the services performed as stated and should be charged to the appropriations(s) 

and/or fund)s) as indicated below; or that the advance payment requested is approved and should be paid as indicated. 

 ...................................................................................................................... 

 (Authorized administrative or certifying officer) 

.......................................................................................................... 

 (Date) 

 ..................................................................................................................... 

 (Title) 

ACCOUNTING CLASSIFICATION Office Charged

Paid by Check No 

NSN 7540-00-634-4230 U.S. G. F. C. 1983 - 381 526-8279 Previous Editions Are Usable 

 Standard Form - LLL-A