[Federal Register Volume 60, Number 43 (Monday, March 6, 1995)]
[Notices]
[Pages 12220-12240]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-5409]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families and the Public Health Service
[Program Announcement No. OCS 95-12]


Family Violence Prevention and Services Program

AGENCY: Office of Community Services, Administration for Children and 
Families; Centers for Disease Control and Prevention, Public Health 
Service; and the Substance Abuse and Mental Health Services 
Administration, Public Health Service; in the Department of Health and 
Human Services (HHS).

ACTION: Notice of the availability of financial assistance and request 
for applications to establish a National Domestic Violence Hotline.

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SUMMARY: The Office of Community Services, Administration for Children 
and Families, in cooperation with the Centers for Disease Control and 
Prevention and Substance Abuse and Mental Health Services 
Administration, announces the availability of funds in fiscal year 1995 
for the award of one cooperative agreement on a competitive basis to 
operate a national, toll-free telephone hotline to provide information 
and assistance to victims of domestic violence. This announcement 
contains all of the application materials needed to apply for this 
cooperative agreement.
    The purpose of the national domestic violence hotline is to provide 
information and referral services, counseling, and assistance to 
victims of domestic violence, their children and other family members, 
and others affected by such violence and to enable them to find safety 
and protection in crisis situations. The successful applicant will be 
required to provide telephonic assistance on a 24 hour-per-day, seven 
day-a-week basis throughout the continental United States, and in 
Alaska, Hawaii, the Commonwealth of Puerto Rico, and the Virgin 
Islands.

DATES: The closing date for submission of applications is June 5, 1995.

ADDRESSES: Applications may be mailed to the Department of Health and 
Human Services, Administration for Children and Families/Division of 
Discretionary Grants, 370 L'Enfant Promenade, SW., 6th Floor, (OCS 95-
12) Washington, DC. 20447.
    Hand delivered applications are accepted during the normal working 
hours of 8 a.m. to 4:30 p.m., Monday through Friday, on or prior to the 
established closing date at:
    Administration for Children and Families, Division of Discretionary 
Grants, 901 D Street, SW., 6th Floor (OCS 95-12), OFM/DDG, Washington, 
DC 20447.

FOR FURTHER INFORMATION CONTACT: William D. Riley, Administration for 
Children and Families, Office of Community Services, Division of State 
Assistance, 370 L'Enfant Promenade, S.W., Washington, DC. 20447. 
Telephone (202) 401-5529.

SUPPLEMENTARY INFORMATION: This program announcement consists of four 
parts. Part I provides information on the legislative authority 
applicable to this announcement and background information on the 
proposed national domestic violence hotline. Part II describes the 
minimum requirements for the design of the hotline that the applicant 
must address in its application. Part III describes the evaluation 
criteria. Part IV provides information and instructions for the 
development and submission of an application.
    The forms to be used for submitting an application follow Part IV. 
Please copy and use these forms in submitting an application under this 
announcement. No additional application materials are available or 
needed to submit an application.
    Applicants should note that the cooperative agreement to be awarded 
under this program announcement is subject to the availability of 
funds.

Part I: General Information

A. Legislative Authority

    Title III of the Child Abuse Amendments of 1984, (Pub. L. 98-457, 
42 U.S.C. 10401, et seq.) is entitled the Family Violence Prevention 
and Services Act (the Act). The Act was first implemented in FY 1986, 
was reauthorized and amended in 1992 by Pub. L. 102-295, and was 
reauthorized and amended for fiscal years 1996 through 2000 by Pub. L. 
103-322, the Violent Crime Control and Law Enforcement Act of 1994 
(Crime Bill), signed into law on September 13, 1994.
    One part of the Crime Bill, the Violence Against Women Act, added 
section 316 to the Family Violence Prevention and Services Act to 
authorize a grant award for up to five years to provide for the 
operation of a national, toll-free telephone hotline to provide 
information and assistance to victims of domestic violence.

B. Conceptual Framework and Scope of Services

    The prevalence of family violence is widespread and its effective 
prevention and treatment requires coordination and collaboration among 
a broad range of legal, justice system, health, and social service 
providers, and advocates at the Federal, State and local levels.
    To serve the wide range of expected calls effectively, the hotline 
must have expertise about domestic violence and services to victims of 
domestic violence. The staff also must understand the importance of 
using appropriate linkages with State and local resources to serve 
callers to the hotline. The benefits of a highly visible national 
hotline to victims and others will be directly related to the 
productive working relationships and coordinated provision of services 
between and among the hotline and State and local hotlines and other 
services and resources.
    Calls to the hotline may range from the urgent and life-threatening 
to calls for general reference information. The target population to be 
served by the hotline is specified in the statute as ``victims of 
domestic violence.'' The hotline should be prepared to respond to the 
broad range of violence that [[Page 12221]] occurs in the context of 
family and intimate relationships, domestic violence, spouse abuse, 
partner abuse, battering of women, sexual assault, date rape, and 
acquaintance rape. The hotline also will serve those less directly 
affected by such abuse, e.g., relatives, children of victims and other 
family members, friends, neighbors, perpetrators and batterers, other 
concerned individuals, and the general public.
    In terms of the scope of the services provided by the hotline, the 
statute requires the provision of ``information and assistance'' and 
``counseling and referral services.'' Therefore, the applicants' 
proposed design and plan for operating the hotline and responding to 
callers is important. However, the hotline is not expected to provide 
extended or long-term counseling or therapy services. The fuller 
discussion of a problem and consideration of options is done most 
appropriately at the local level, given the variation in laws and 
services available among the States and localities.
    Finally, because domestic violence often contributes to isolation, 
helplessness, loss of self-esteem, and dependence, a self-help and 
empowerment model of services is needed. Such a model:
    <bullet> Protects and assures safety for all victims and other 
family members;
    <bullet> Builds on the strengths and resources of individuals and 
families;
    <bullet> Offers options and support for independent decision-making 
based on specific individual and family needs and circumstances; and
    <bullet> Assists individuals and families to obtain protection and 
needed services that are respectful of cultural and community 
characteristics.
    Finally, we recognize that there is an inter-relationship between 
alcohol, drug abuse, and mental health (ADM) problems and domestic 
violence. Alcohol abuse has been demonstrated to contribute to violent 
behavior. Moreover, the abuse of alcohol coupled with other drugs is 
even more likely to be associated with severe battering incidents than 
is alcohol by itself. Victims of and or witnesses to domestic violence 
also may experience psychological consequences or turn to substance to 
ameliorate their pain. In addition to physical trauma resulting from 
acts of physical abuse, battered women suffer from a number of mental 
health consequences, including higher levels of depression, drug and 
alcohol abuse, suicide attempts, and low self-esteem. Many of the 
mental health consequences of spousal violence result from chronic 
intimidation and fear, which are often as significant as the actual, 
acts of physical aggression. Witnessing spousal violence contributes to 
the cycle of violence outside the home. There is an increased 
likelihood of child abuse in homes where there has already been spouse 
abuse.

C. Eligible Applicants

    Any private nonprofit agency, organization, institution, Tribal 
organization, or combination thereof, is eligible to apply for these 
funds. Any nonprofit organization submitting an application must submit 
proof of its nonprofit 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 Service's (IRS) 
most recent list of tax-exempt organizations described in Section 
501(c)(3) of the IRS Code or by providing a copy of the currently valid 
IRS tax exemption certificate, or by providing a copy of the articles 
of incorporation bearing the seal of the State in which the corporation 
or association is domiciled.

D. Availability of Funds

    As authorized by section 316 of the Act, the Office of Community 
Services will award one cooperative agreement in FY 1995 of a maximum 
of $1 million for the implementation of the toll-free rational domestic 
violence hotline. The source of these funds will be the Crime Bill 
Trust Fund.
    Non-competitive continuation grant awards for each of years two 
through five (FYs 1996-1999) will be a maximum of $850,000, subject to 
the availability of funds. This total represents $400,000 from the 
Crime Bill Trust Fund for the operation of the hotline and $450,000 to 
be used to carry out additional statutory and programmatic activities 
on behalf of the Centers for Disease Control and Prevention (CDC), the 
Substance Abuse and Mental Health Services Administration (SAMHSA), and 
the Office of Community Services (OCS).
    Because the national hotline is viewed as a viable mechanism to 
achieve a number of specific aims, in each of years two through five 
CDC plans to provide $250,000 under section 393 of the Public Health 
Services Act to provide additional support for State and local domestic 
violence hotlines in response to the demand generated by the national 
public awareness campaign; SAMHSA plans to provide $100,000 under 
appropriate FY 1996 statutory authorities to enhance the hotline 
database to include ADM resources, support the training of hotline 
staff to assure that they are knowledgeable about ADM involvement in 
incidents of domestic violence and can make appropriate referrals to 
ADM services, and, to the extent possible, collect such information 
from callers; and OCS plans to provide $100,000 under section 305 of 
the Family Violence Prevention and Services Act to support additional 
compilation and reporting of information based on calls to the hotline. 
These supplemental activities are described in greater detail as 
grantee requirements in Part II of this announcement.
    Section 316 of the Act also states that funds appropriated and 
awarded from the Crime Trust Fund will remain available until expended, 
i.e., the $1 million in FY 1995 and $400,000 in FYs 1996-1999. This 
provides additional flexibility to the grantee in the timing and use of 
these funds. The funds for additional purposes in FYs 1996-1999 
($450,000 in each of years two through five) must be expended by the 
end of the fiscal year following receipt of the funds.

E. Duration of Project

    The Office of Community Services, in cooperation with CDC and 
SAMHSA, will award one grant, as a cooperative agreement, for up to 
five years (60-month project period). The initial grant award, to be 
made on a competitive basis, will cover a 12-month budget period. 
Application for continuation funding beyond the initial 12-month budget 
period, but within the 60-month project period, will be considered in 
subsequent years on a non-competitive basis, subject to the approval of 
the Secretary, the availability of funds, the satisfactory performance 
of the grantee, and the determination that the continued funding and 
support of the project would be in the best interest of the government.

F. Cooperative Agreement

    The Office of Community Services intends to support the national 
toll-free hotline through a cooperative agreement. A cooperative 
agreement is Federal financial aid in which substantial Federal 
involvement is anticipated. The responsibilities of the Administration 
for Children and Families and of the successful applicant will be 
identified and incorporated into the cooperative agreement during pre-
award negotiations. It is anticipated that ACF responsibilities will 
not change the project requirements found in Part II of this 
announcement.
    The grantee will outline a plan of interaction with OCS for 
implementation under a cooperative [[Page 12222]] agreement including, 
as appropriate, activities involving Federal staff. The plan under the 
cooperative agreement will describe the general and specific 
responsibilities of the grantee and the grantor as well as foreseeable 
joint responsibilities. A schedule of tasks will be developed and 
agreed upon in addition to any special conditions relating to the 
implementation of the hotline.

G. Grantee Share of the Project

    The grantee must provide at least 25 percent of the total approved 
cost of the project. The total approved cost of the project is the sum 
of the Federal share and the non-Federal share. The non-Federal share 
may be met by cash or in-kind contributions, although applicants are 
encouraged to meet their match requirements through cash contributions. 
Therefore, a project requesting $1,000,000 in Federal funds for the 
first year budget period must include a match of at least $333,333 (25 
percent of total project cost). If approved for funding, the grantee 
will be held accountable for commitments of non-Federal resources, and 
failure to provide the required amounts will result in a disallowance 
of unmatched Federal funds.

Part II: Project Requirements

Requirements for Project Implementation

    The following requirements must be met by the grantee and addressed 
in the application:
    1. All funds received by the grantee pursuant to Section 316 of the 
Act must be used to establish and operate a national toll-free, 
telephone hotline to provide information and assistance to victims of 
domestic violence.
    2. In establishing the hotline, the private, nonprofit entity 
shall--
    <bullet> Contract with a carrier for the use of a toll-free 
telephone line;
    <bullet> Employ, train, and supervise personnel to answer incoming 
calls and provide counseling and referral services on a 24-hour-a-day 
basis;
    <bullet> Assemble and maintain a current database of information 
relating to services for victims of domestic violence to which callers 
may be referred throughout the United States, including information on 
the availability of shelters that serve battered women and their 
children; and
    <bullet> Publicize the hotline to potential users throughout the 
united States.
    3. To be approved by the Secretary, the application must include a 
complete description of the applicant's plan for the operation of a 
national domestic violence hotline, including description of--
    <bullet> The training program for hotline personnel;
    <bullet> The hiring criteria for hotline personnel;
    <bullet> The methods for the creation, maintenance, and updating of 
a resource database;
    <bullet> A plan for publicizing the availability of the hotline;
    <bullet> A plan for providing service to non-English speaking 
callers, including hotline personnel who speak Spanish; and
    <bullet> A plan for facilitating access to the hotline by persons 
with hearing impairments.
    4. The applicant must demonstrate that it has:
    <bullet> Nationally recognized expertise in the area of domestic 
violence and a record of high quality service to victims of domestic 
violence, including a demonstration of support from advocacy groups, 
such as domestic violence State coalitions or recognized national 
domestic violence groups; and
    <bullet> A commitment to diversity, and to the provision of 
services to ethnic, racial, and non-English speaking minorities, in 
addition to older individuals and individuals with disabilities.
    5. The applicant must demonstrate knowledge of the field, including 
the range of services and the resources available for domestic violence 
victims, their children and family members, perpetrators and batterers, 
and other concerned individuals, including services and resources 
relating to substance and mental health problems; State and Indian 
tribal domestic violence laws, including the availability of legal 
protection; and the barriers affecting access to such services, 
resources and protection.
    6. The applicant must demonstrate experience in providing high-
quality crisis intervention, information and referral, and counseling 
services and support to battered women, their children, other domestic 
violence victims, their family and friends, batterers, and the general 
public.
    7. The applicant must demonstrate an understanding of the 
relationship of alcohol, drug abuse, and mental health (ADM) problems 
to incidents of domestic violence and the ability to make appropriate 
referrals to callers.
    8. The applicant must demonstrate an understanding of the need for 
a national hotline for domestic violence victims, including a 
description of the function and limitation of the current network of 
national and State crisis hotlines, information lines, and State 
victims referral services.
    9. The applicant must provide a plan and demonstrated ability to 
build, maintain, and keep current a comprehensive database of resource 
information, including the full range of services available in local 
communities, the types of legal protection and services available in 
different States and localities, and the capability to access 
information.
    10. The applicant must provide a detailed description of:
    <bullet> The telecommunications and computer technology that will 
be employed to establish and support the hotline, including all 
management functions, referral functions, resource database management 
functions, monitoring functions, and overall project administration and 
quality control, including periodic reporting to HHS;
    <bullet> The design and operation of the telephone system that will 
be used to provide the service; its capacity and its limitations, 
including information such as the capacity to facilitate the number of 
incoming calls, call conferencing, automatic call referral to local 
providers, and service integration with computers.
    <bullet> The methods that will be used to ensure that the national 
hotline is a confidential crisis intervention and the specific 
provisions that will be in place to safeguard the confidentiality of 
callers and ensure the proper handling of confidential or sensitive 
information;
    <bullet> The personnel recruitment, hiring, and training program 
(i.e., a description of an initial and ongoing training plan for staff 
and volunteers should be included in this section) that will ensure the 
delivery of quality crisis intervention, information and referral, 
assistance, and counseling services to diverse populations;
    <bullet> The specific emergency response and crisis protocol to be 
used, the ability to conference call (or ``patch'') a caller to a local 
domestic violence, legal services, or mental health or substance abuse 
program when appropriate, and the plans for minimizing such problems as 
crank/obscene calls and busy signals; and
    <bullet> The methods the applicant will use to provide for the 
development, maintenance, and updating of a comprehensive resource 
database (distributed to the maximum extent appropriate); the technical 
capacity to link with other State and local databases in order to 
maintain an extensive and current resource locator or listing; the 
ability to facilitate communication among service providers to assist 
the [[Page 12223]] provision of services; and how the information on 
best practices gathered through the inventory being conducted by CDC 
will be used to assist victims. 11. The applicant must demonstrate an 
understanding of the technological requirements of such a project and 
include a detailed timeline to provide the following services 
nationally:
    <bullet> 24-hour/365 days per year access;
    <bullet> Direct access to English and Spanish-speaking personnel at 
all times and provision for services to other non-English speaking 
callers and the hearing impaired;
    <bullet> Personnel (paid staff and volunteers) trained in crisis 
intervention, information and referral, and counseling skills;
    <bullet> Comprehensive database of current information;
    <bullet> The ability to connect callers directly to local programs 
or services when appropriate;
    <bullet> Emergency response protocol for callers in immediate 
danger; and
    <bullet> Appropriate confidentiality safeguards; and data 
collection and data management capability sufficient to support program 
administration, reporting, monitoring, and an ongoing quality 
assessment of the hotline service.
    12. The applicant must provide a plan to coordinate, work with, and 
provide hotline services and data resource and referrals that make 
maximum use of existing domestic violence programs and resources, 
including, but not limited to, local and State-wide domestic violence 
hotlines, State Domestic Violence Coalitions, shelter programs, 
emergency services, legal services programs, national domestic violence 
resource centers, other existing national hotlines, and other national 
organizations; resources related to child abuse and youth endangerment, 
ADM problems, and perpetrators and batterers programs, the national 
domestic violence media campaign coordinated by the Family Violence 
Prevention Fund, and the various activities of the Centers for Disease 
Control under its campaign to prevent violence against women. The 
applicant must provide support to State and local domestic violence 
hotlines in response to the demand generated by the national public 
awareness campaign.
    13. The applicant must provide a description of the quality 
assurance system it will use to assess regularly the quality of the 
services being provided by the hotline and the extent to which the 
goals and objectives of the service are being met. The quality 
assurance system also must include actions to address identified 
problems.
    14. The applicant must provide a comprehensive plan to publicize 
the hotline to a wide national audience, including efforts to ensure 
promotion through the national media and through targeted outreach to 
racially and ethnically diverse communities, older individuals, and 
individuals with disabilities.
    15. The applicant must demonstrate the ability to staff, 
financially support, and programmatically administer a national project 
of this scope.
    16. The author(s) of the application must be clearly identified 
together with a description of his or her current relationship to the 
applicant organization and any future project role he or she may have 
if the project is funded.
    17. The applicant must provide an assurance that any information 
collected as a part of this grant will become the property of the 
Federal Government.
    18. The applicant must provide an assurance that it will work with 
the Federal Project Officer to identify the information that will be 
compiled based on incoming calls including compilation of information 
on both maternal and child victims of domestic violence and individual 
and situational factors characterizing violent and abusive behavior.
    19. The applicant must provide an assurance that it will comply 
with the grant administration requirements in 45 CFR part 74.

Part III: Evaluation Criteria

    The five criteria that follow will be used to review and evaluate 
how each application has addressed the requirements stated in Part II 
and should be used in developing the program narrative. The point 
values following each criterion heading indicate the maximum numerical 
weight that each section will be given in the review process.

1. Need for the Project (10 Points)

    Provide a detailed discussion of the need for a national domestic 
violence hotline of the scope being proposed. Provide a detailed 
analysis of the available data related to the problem being addressed 
(both domestic violence in general and the specific lack of a national 
domestic violence hotline); the strengths and limitations of other 
national and local crisis intervention and victim services hotline/
referral services available, and the ``state-of-the-art'' relative to 
the problem being addressed by the proposal.

2. Goals and Objectives (10 Points)

    Clearly state the project goals and objectives. Objectives should 
be stated in concrete, measurable terms which clearly identify the 
population(s) to be served, the type, quality, and level of service to 
be provided, the timeline for the establishment and delivery of 
services, and other project benchmarks. The anticipated demand for 
hotline services during the initial start-up period and a projection of 
the demand on an ongoing basis should be discussed, with supporting 
documentation. Describe the precise location of the project.

3. Approach (30 Points)

    Provide a sound workable plan of action (approach) which details: 
how the proposed work will be accomplished; how each task relates to 
the project's goals and activities; identifies the key staff member 
responsible for the specific tasks; provides a chart indicating the 
timetable for completing each task, the phasing in of the tasks over 
time, the lead staff person, and the time committed to the task; cites 
factors which might accelerate or decelerate the work; justifies the 
approach selected over other approaches; makes maximum use of existing 
facilities and resources and off-the-shelf technology; describes and 
supports any unusual features of the project, such as design or 
technological innovations, reductions in cost or time, or extraordinary 
social or community involvement; and provides projections of the 
accomplishments to be achieved and identifies the activities for which 
Federal technical assistance, advice, or guidance as the project is 
implemented is anticipated and would be acceptable.

4. Results and Benefits Expected (20 Points)

    Identify, in specific terms, the results and benefits to be derived 
from the project and relate each result and benefit to a specific 
objective. Indicate the aggregate number of calls expected to be 
received and individuals to be assisted on an annual basis, e.g., the 
expected volume of calls in such service areas as crisis counseling, 
immediate referrals to shelters, or the number of referrals made in 
response to non-English speaking callers. Indicate the anticipated 
impact on and the subsequent benefit of the national hotline to victims 
of domestic violence and on the existing network of State and local 
shelters and services. Identify the kinds of data to be collected, 
maintained, and updated, and discuss [[Page 12224]] the criteria to be 
used to assure the quality of the services provided.

5. Level of Effort (30 Points)

    Expertise, Commitment, and Support. The extent to which the 
applicant has nationally recognized expertise in the area of domestic 
violence and a record of high quality service to victims of domestic 
violence, including a demonstration of support from advocacy groups, 
such as State Domestic Violence Coalitions or recognized national 
domestic violence groups; the extent of the applicant's commitment to 
diversity, and to the provision of service to ethnic, racial, and non-
English speaking minorities, older individuals, and individuals with 
disabilities.
    Staff Background and Organizational Experience. The adequacy of the 
staffing pattern for the proposed project, how the individual 
responsibilities are linked to project tasks, and the contributions to 
be made by key staff. Each collaborating or cooperative organization, 
individual consultant, or other key individuals who will work on the 
project should be listed along with a description of the nature of 
their effort or contribution.
    Competence of Staff. The background and experience of the project 
director and key project staff and the history and accomplishments of 
the organization; the qualifications of the project team including any 
experience with similar projects; the variety of skills, relevant 
educational background, and the ability to effectively manage the 
project and to coordinate activities with other agencies. One or two 
pertinent paragraphs on each key member are preferred to vitae/resumes. 
However, vitae/resumes may be included.
    Adequacy of Resources. The adequacy of the available resources and 
organizational experience with regard to the tasks of the proposed 
project. List the financial, physical, and other resources already 
committed by other public and private agencies and institutions, if 
any. Explain how these organizations will participate in the day to day 
operations of the project. Letters from these agencies and 
organizations identifying and discussing the specifics of their 
commitment and participation must be included in the application.
    Budget. Relate the proposed budget to the level of effort required 
to obtain the project objectives. Demonstrate that the project's costs 
are reasonable in view of the anticipated results.
    Collaborative Efforts. The additional anticipated private sector 
resources that may be available to support or enhance the overall 
program. Discuss in detail and provide documentation for any proposed 
collaborative or coordinated efforts with other public and private 
agencies or organizations. Identify these agencies or organizations and 
explain how their participation will enhance the project. Letters from 
these agencies and organizations must be included discussing their 
interest and/or commitment in supporting this project, the stage of the 
planning and decision-making, and the expected level of resource 
commitment.

Part IV: Instructions for the Development and Submission of 
Applications

    This Part contains information and instructions for submitting 
applications in response to this announcement. Application forms are 
provided as part of this publication along with a checklist for 
assembling an application package. Please copy and use these forms in 
submitting an application.
    Potential applicants should read this section carefully in 
conjunction with the information describing the proposed project under 
which the application is to be submitted. The project design 
requirements are found in Part II.

A. Required Notification of the State Single Point of Contact

    This program is covered under Executive Order 12372, (E.O.) 
``Intergovernmental Review of Federal Programs,'' and 45 CFR Part 100, 
``Intergovernmental Review of Department of Health and Human Services 
Program and Activities.'' Under the E.O., States may design their own 
processes for reviewing and commenting on proposed Federal assistance 
under covered programs.
    All States and territories, except Alabama, Alaska, Colorado, 
Connecticut, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana, 
Nebraska, Oklahoma, Oregon, Pennsylvania, South Dakota, Virginia, 
Washington, American Samoa, and Palau, have elected to participate in 
the E.O. process and have established Single Points of Contact (SPOCs). 
Applicants from these nineteen jurisdictions need take no action 
regarding E.O. 12372. Otherwise, applicants should contact their SPOCs 
as soon as possible to alert them of the prospective applications and 
receive any necessary instructions. Applicants must submit any required 
material to the SPOCs as soon as possible so that OCS can obtain and 
review SPOC comments as part of the award process. It is imperative 
that the applicant 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 application 
deadline to comment on proposed new or competing continuation awards.
    SPOCs are encouraged to eliminate the submission of routine 
endorsements as official recommendations. Additionally, SPOCs are 
requested to differentiate clearly 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, (OCS-95-
12) 370 L'Enfant Promenade, SW., 6th Floor, Washington, DC 20447.
    A list of the Single Points of Contact for each State and Territory 
is included at the end of this announcement.

B. Deadline for Submittal of Applications

    The closing date for submittal of applications under this program 
announcement is found at the beginning of this program announcement 
under DATES. Applications shall be considered as meeting the announced 
deadline if they are either:
    1. Received on or before the deadline date at the Department of 
Health and Human Services, Administration for Children and Families, 
Division of Discretionary Grants, (OCS-95-12) 370 L'Enfant Promenade, 
SW., 6th Floor, Washington, DC 20447, or
    2. Sent on or before the deadline date and received by OCS in time 
to be considered during the competitive review process.
    Applications must be postmarked no later than the date to be found 
at the beginning of the Program Announcement under DATES. When mailing 
application packages, applicants are strongly advised to obtain a 
legibly dated receipt from a commercial carrier (such as UPS, Federal 
Express, etc.) or from the U.S. Postal Service as proof of mailing by 
the deadline date. Private metered postmarks are not acceptable as 
proof of timely mailing.
    Late applications. Applications which do not meet the criteria 
under ``Deadlines'' are considered late applications. The ACF shall 
notify each late applicant that its application will not be considered 
in the current competition.
    Extension of deadlines. The ACF reserves the right to extend the 
deadline [[Page 12225]] for all applicants due to acts of God, such as 
floods, hurricanes or earthquakes; if there is widespread disruption of 
the mail; or if ACF determines a deadline extension to be in the best 
interest of the Government. However, ACF will not waive or extend the 
deadline for any applicant unless the deadline is waived or extended 
for all applicants.

C. Instructions for Preparing the Application and Completing 
Application Forms

    The SF 424, SF 424A, Page 2, and the required certifications have 
been reprinted for your convenience in preparing the application. You 
should reproduce single-sided copies of these forms from the reprinted 
forms in the announcement, typing your information onto the copies. 
Please do not use forms directly from the Federal Register 
announcement, as they are printed on both sides of the page.
    In order to assist applicants in correctly completing the SF 424 
and SF 424A, instructions for these forms are included below.
    Where specific information is not required under this program, NA 
(not applicable) has been preprinted on the form.

Please Prepare Your Application in Accordance With The Following 
Instructions:

1. SF 424  Page 1, Application Cover Sheet
    Please read the following instructions before completing the 
application cover sheet. An explanation of each item is included. 
Complete only the items specified.
    Top of Page! Enter designation ``HTL.''
    Item 1! ``Type of Submission''--Preprinted on the form.
    Item 2! ``Date Submitted'' and ``Applicant Identifier''--Date 
application is submitted to ACF and applicant's own internal control 
number, if applicable.
    Item 3: ``Date Received By State''--State use only (if applicable).
    Item 4: ``Date Received by Federal Agency''--Leave blank.
    Item 5: ``Applicant Information'' ``Legal Name''--Enter the legal 
name of applicant organization.
    ``Organizational Unit''--Enter the name of the primary unit within 
the applicant organization which will actually carry out the project 
activity. Do not use the name of an individual as the applicant. If 
this is the same as the applicant organization, leave the 
organizational unit blank.
    ``Address''--Enter the complete address that the organization 
actually uses to receive mail, since this is the address to which all 
correspondence will be sent. Do not include both street address and 
P.O. box number unless both must be used in mailing.
    ``Name and telephone number, including the area code, of the person 
to be contacted on matters involving this application ``--Enter the 
full name (including academic degree, if applicable) and telephone 
number of a person who can respond to questions about the application. 
This person should be accessible at the address given here and will 
receive all correspondence regarding the application.
    Item 6: ``Employer Identification Number (EIN)''--Enter the 
employer identification number of the applicant organization, as 
assigned by the Internal Revenue Service, including, if known, the 
Central Registry System suffix.
    Item 7: ``Type of Applicant''--Self-explanatory.
    Item 8: ``Type of Application''--Preprinted on the form.
    Item 9: ``Name of Federal Agency''--Preprinted on the form.
    Item 10: ``Catalog of Federal Domestic Assistance Number and 
Title''--Enter the Catalog of Federal Domestic Assistance (CFDA) number 
assigned to the program under which assistance is requested and its 
title. The CFDA number for this program is 93.671.
    Item 11: ``Descriptive Title of Applicant's Project''--Enter the 
project title. The title is generally short and is descriptive of the 
project.
    Item 12: ``Areas Affected by Project''--Enter the governmental unit 
where significant and meaningful impact could be observed. List only 
the largest unit or units affected, such as State, county, or city. If 
an entire unit is affected, list it rather than subunits.
    Item 13: ``Proposed Project''--Enter the desired start date for the 
project and projected completion date.
    Item 14: ``Congressional District of Applicant/Project''--Enter the 
number of the Congressional district where the applicant's principal 
office is located and the number of the Congressional district(s) where 
the project will be located. If statewide, a multi-State effort, or 
nationwide, enter ``00.''
    Items 15: ``Estimated Funding Levels''--
    In completing 15a through 15f, the dollar amounts entered should 
reflect, for a 17 month or less project period, the total amount 
requested. If the proposed project period exceeds 17 months, enter only 
those dollar amounts needed for the first 12 month budget period of the 
proposed five year project period.
    Item 15a: Enter the amount of Federal funds requested in accordance 
with the preceding paragraph. This amount should be no greater than the 
maximum amount specified in the project description.
    Items 15b-e: Enter the amount(s) of funds from non-Federal sources 
that will be contributed to the proposed project. Items b-e are 
considered cost-sharing or ``matching funds.'' The value of third party 
in-kind contributions should be included on appropriate lines as 
applicable. For more information regarding funding and ``matching'' 
requirements, see Part I, Grantee Share of the Project.
    Item 15f: Enter the estimated amount of income, if any, expected to 
be generated from the proposed project. Do not add or subtract this 
amount from the total project amount entered under item 15g. Describe 
the nature, source and anticipated use of this income in the Project 
Narrative Statement. If not applicable, enter N/A.
    Item 15g: Enter the sum of items 15a-15e.
    Item 16a: ``Is Application Subject to Review By State Executive 
Order 12372 Process? Yes.''--Enter the date the applicant contacted the 
SPOC regarding this application. Select the appropriate SPOC from the 
listing provided at the end of Part IV. The review of the application 
is at the discretion of the SPOC. The SPOC will verify the date noted 
on the application. If there is a discrepancy in dates, the SPOC may 
request that the Federal agency delay any proposed funding until 
September 30, 1995.
    Item 16b: ``Is Application Subject to Review By State Executive 
Order 12372 Process? No.''--Check the appropriate box if the 
application is not covered by E.O. 12372 or if the program has not been 
selected by the State for review.
    Item 17: ``Is the Applicant Delinquent on any Federal Debt?''--
Check the appropriate box. This question applies to the applicant 
organization, not the person who signs as the authorized 
representative. Categories of debt include audit disallowances, loans 
and taxes.
    Item 18: ``To the best of my knowledge and belief, all data in this 
application/preapplication are true and correct. The document has been 
duly authorized by the governing body of the applicant and the 
applicant will comply with the attached assurances if the assistance is 
awarded.''--To be signed by the authorized representative of the 
applicant. A copy of the governing body's authorization for signature 
of this [[Page 12226]] application by this individual as the official 
representative must be on file in the applicant's office, and may be 
requested from the applicant.
    Item 18a-c: ``Typed Name of Authorized Representative, Title, 
Telephone Number''--Enter the name, title and telephone number of the 
authorized representative of the applicant organization.
    Item 18d: ``Signature of Authorized Representative''--Signature of 
the authorized representative named in Item 18a. At least one copy of 
the application must have an original signature. Use colored ink (not 
black) so that the original signature is easily identified.
    Item 18e: ``Date Signed''--Enter the date the application was 
signed by the authorized representative.
2. SF 424A--Budget Information--Non-Construction Programs
    This is a form used by many Federal agencies. For this application, 
Sections A, B, C, E and F are to be completed. Section D does not need 
to be completed.
    Sections A and B should include the Federal as well as the non-
Federal funding for the proposed project covering (1) The total project 
period of 17 months or less; or (2) the first 12 month budget period, 
if the proposed project period exceeds 17 months.
    Section A--Budget Summary. This section includes a summary of the 
budget. On line 5, enter total Federal costs in column (e) and total 
non-Federal costs, including third party in-kind contributions, but not 
program income, in column (f). Enter the total of (e) and (f) in column 
(g).
    Section B--Budget Categories. This budget, which includes the 
Federal as well as non-Federal funding for the proposed project, covers 
(1) The total project period of 17 months or less or (2) the first 12 
month budget period if the proposed project period exceeds 17 months. 
It should relate to item 15g, total funding, on the SF 424. Under 
column (5), enter the total requirements for funds (Federal and non-
Federal) by object class category.
    A separate budget justification should be included to explain fully 
and justify major items, as indicated below. The types of information 
to be included in the justification are indicated under each category. 
For multiple year projects, it is desirable to provide this information 
for each year of the project. The budget justification should 
immediately follow the second page of the SF 424A.
    Personnel--Line 6a. Enter the total costs of salaries and wages of 
applicant/grantee staff. Do not include the costs of consultants, which 
should be included on line 6h, ``Other.''
    Justification: Identify the project director, if known. 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.
    Fringe Benefits--Line 6b. Enter the total costs of fringe benefits, 
unless treated as part of an approved indirect cost rate.
    Justification: Provide a break-down of amounts and percentages that 
comprise fringe benefit costs, such as health insurance, FICA, 
retirement insurance, etc.
    Travel--Line 6c. Enter total costs of out-of-town travel (travel 
requiring per diem) for staff of the project. Do not enter costs for 
consultant's travel or local transportation, which should be included 
on Line 6h, ``Other.''
    Justification: Include the name(s) of traveler(s), total number of 
trips, destinations, length of stay, transportation costs and 
subsistence allowances.
    Equipment--Line 6d. Enter the total costs of all equipment to be 
acquired by the project. For State and local governments, including 
Federally recognized Indian Tribes, ``equipment'' is tangible, non-
expendable personal property having a useful life of more than one year 
and an acquisition cost of $5,000 or more per unit. For all other 
applicants, the threshold for equipment is $5,000 or more per unit. The 
higher threshold for State and local governments became effective 
October 1, 1988, through the implementation of 45 CFR Part 92, 
``Uniform Administrative Requirements for Grants and Cooperative 
Agreements to State and Local Governments.''
    Justification: Equipment to be purchased with Federal funds must be 
justified. The equipment must be required to conduct the project, and 
the applicant organization or its subgrantees must not have the 
equipment or a reasonable facsimile available to the project. The 
justification also must contain plans for future use or disposal of the 
equipment after the project ends.
    Supplies--Line 6e. Enter the total costs of all tangible expendable 
personal property (supplies) other than those included on Line 6d.
    Justification: Specify general categories of supplies and their 
costs.
    Contractual--Line 6f: Enter the total costs of all contracts, 
including procurement contracts (except those which belong on other 
lines such as equipment, supplies, etc.) and contracts with secondary 
recipient organizations. Also include any contracts with organizations 
for the provision of technical assistance. Do not include payments to 
individuals on this line.
    Justification: Attach a list of contractors, indicating the names 
of the organizations, the purposes of the contracts, and the estimated 
dollar amounts of the awards as part of the budget justification. 
Whenever the applicant/grantee intends to delegate part or all of the 
program to another agency, the applicant/grantee must complete this 
section (Section B, Budget Categories) for each delegate agency by 
agency title, along with the supporting information. The total cost of 
all such agencies will be part of the amount shown on Line 6f. Provide 
backup documentation identifying the name of contractor, purpose of 
contract, and major cost elements.
    Construction--Line 6g: Not applicable. New construction is not 
allowable.
    Other--Line 6h: Enter the total of all other costs. Where 
applicable, such costs may include, but are not limited to: Insurance; 
medical and dental costs; noncontractual 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. Note that costs identified as ``miscellaneous'' and 
``honoraria'' are not allowable.
    Justification: Specify the costs included.
    Total Direct Charges--Line 6i: Enter the total of Lines 6a through 
6h.
    Indirect Charges--6j: Enter the total amount of indirect charges 
(costs). If no indirect costs are requested, enter ``none.'' Generally, 
this line should be used when the applicant (except local governments) 
has a current indirect cost rate agreement approved by the Department 
of Health and Human Services or another Federal agency.
    Local and State governments should enter the amount of indirect 
costs determined in accordance with HHS requirements. When an indirect 
cost rate is requested, these costs are included in the indirect cost 
pool and should not be charged again as direct costs to the grant.
    Justification: Enclose a copy of the indirect cost rate agreement. 
Applicants subject to the limitation on the Federal reimbursement of 
indirect costs for training grants should specify this. [[Page 12227]] 
    Total--Line 6k: Enter the total amounts of lines 6i and 6j.
    Program Income--Line 7: Enter 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.
    Justification: Describe the nature, source, and anticipated use of 
program income in the Program Narrative Statement.
    Section C--Non-Federal Resources. This section summarizes the 
amounts of non-Federal resources that will be applied to the grant. 
Enter this information on line 12 entitled ``Totals.'' ``In-kind 
contributions'' are defined in title 45 of the Code of Federal 
Regulations, Part 74.2, as ``the value of non-cash contributions 
provided by non-Federal third parties. Third party in-kind 
contributions may be in the form of real, property, equipment, supplies 
and other expandable property, and the value of goods and services 
directly benefiting and specifically identifiable to the project or 
program.''
    Justification: Describe third party in-kind contributions, if 
included.
    Section D--Forecasted Cash Needs. Not applicable.
    Section E--Budget Estimate of Federal Funds Needed for Balance of 
the Project. This section should only be completed if the total project 
period exceeds 17 months.
    Totals--Line 20: For projects that will have more than one budget 
period, enter the estimated required Federal funds for the second 
budget period (months 13 through 24) under column ``(b) First.'' If a 
third budget period will be necessary, enter the Federal funds needed 
for months 25 through 36 under ``(c) Second.'' Columns (d) and (e) are 
not applicable in most instances, since ACF funding is almost always 
limited to a three-year maximum project period. They should remain 
blank.
    Section F--Other Budget Information.
    Direct Charges--Line 21: Not applicable.
    Indirect Charges--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.
    Remarks--Line 23. If the total project period exceeds 17 months, 
you must enter your proposed non-Federal share of the project budget 
for each of the remaining years of the project.
3. Project Summary Description
    Clearly mark this separate page with the applicant name as shown in 
item 5 of the SF 424, and the title of the project as shown in item 11 
of the SF 424. The summary description should not exceed 300 words. 
These 300 words become part of the computer database on each project.
    Care should be taken to produce a summary description which 
accurately and concisely reflects the proposal. It should describe the 
objectives of the project, the approaches to be used and the outcomes 
expected. The description should also include a list of major products 
that will result from the proposed project, such as software packages, 
materials, management procedures, data collection instruments, training 
packages, or videos (please note that audiovisuals should be closed 
captioned). The project summary description, together with the 
information on the SF 424, will constitute the project ``abstract.'' It 
is the major source of information about the proposed project and is 
usually the first part of the application that the reviewers read in 
evaluating the application.
4. Program Narrative Statement
    The Program Narrative Statement is a very important part of an 
application. It should be clear, concise, and address the specific 
requirements mentioned under the project description in Part II. The 
narrative should also provide information concerning how the 
application meets the evaluation criteria using the following headings:

(a) Need for the Project
(b) Goals and Objectives
(c) Approach
(d) Results and Benefits Expected
(e) Level of Effort

The specific information to be included under each of these headings is 
described in Part III, Evaluation Criteria.
    The narrative should be typed double-spaced on a single-side of an 
8\1/2\'' x 11'' plain white paper, with 1'' margins on all sides. All 
pages of the narrative (including charts, references/footnotes, tables, 
maps, exhibits, etc.) must be sequentially numbered, beginning with 
``Need for the Project'' as page number one. Applicants should not 
submit reproductions of larger size paper, reduced to meet the size 
requirement. There is no page limit on the length of the narrative.
    The length of the remainder of the application, including the 
application forms and all attachments, should not exceed 60 pages. A 
page is a single side of an 8\1/2\'' x 11'' sheet of paper. Applicants 
are requested not to send pamphlets, brochures or other printed 
material along with their application as these pose photocopy 
difficulties. These materials, if submitted, will not be included in 
the review process if they exceed the 60-page limit. Each page of the 
application will be counted to determine the total length.
5. Organizational Capability Statement
    The Organizational Capability Statement should consist of a brief 
(two to three pages) background description of how the applicant 
organization (or the unit within the organization that will have 
responsibility for the project) is organized, the types and quantity of 
services it provides, and/or the research and management capabilities 
it possesses. This description should cover capabilities not included 
in the Program Narrative Statement. It may include descriptions of any 
current or previous relevant experience, or describe the competence of 
the project team and its demonstrated ability to produce a final 
product that is readily comprehensible and usable. An organization 
chart showing the relationship of the project to the current 
organization should be included.
6. Assurances/Certifications
    Applicants are required to file an SF 424B, Assurances-- Non-
Construction Programs, and the Certification Regarding Lobbying. Both 
must be signed and returned with the application. In addition, 
applicants must certify their compliance with: (1) Drug-Free Workplace 
Requirements; and (2) Debarment and Other Responsibilities; and (3) 
Certification Regarding Environmental Tobacco Smoke. These 
certifications are self-explanatory. Copies of these assurances/
certifications are reprinted at the end of this announcement and should 
be reproduced, as necessary. A duly authorized representative of the 
applicant organization must certify that the applicant is in compliance 
with these assurances/certifications. A signature on the SF 424 
indicates compliance with the Drug Free Workplace Requirements, the 
Debarment and Other Responsibilities, and the Environmental Tobacco 
Smoke certifications.

D. Checklist for a Complete Application

    The checklist below is for your use to ensure that your application 
package has been properly prepared.

______One original, signed and dated application, plus two copies. 
Applications for different priority areas are packaged separately;
______Application is from an organization which is eligible under the 
eligibility requirements defined [[Page 12228]] in the priority area 
description (screening requirement);
______Application length, excluding the narrative, does not exceed 60 
pages, unless otherwise specified in the project description.
______A complete application consists of the following items in this 
order:
    ______Application for Federal Assistance (SF 424, REV 4-88);
    ______A completed SPOC certification with the date of SPOC contact 
entered in line 16, page 1 of the SF 424 if applicable.
    ______Budget Information--Non-Construction Programs (SF 424A, REV 
4-88);
    ______Budget justification for Section B--Budget Categories;
    ______Table of Contents;
    ______Letter from the Internal Revenue Service to prove non-profit 
status, if necessary;
    ______Copy of the applicant's approved indirect cost rate 
agreement, if appropriate;
    ______Project summary description and listing of key words;
    ______Program Narrative Statement (See Part III);
    ______Organizational capability statement, including an 
organization chart;
    ______Any appendices/attachments;
    ______Assurances--Non-Construction Programs (Standard Form 424B, 
REV 4-88); and
    ______Certification Regarding Lobbying.

E. The Application Package

    Each application package must include an original and two copies of 
the complete application. Each copy should be stapled securely (front 
and back if necessary) in the upper left-hand corner. All pages of the 
narrative (including charts, tables, maps, exhibits, etc.) must be 
sequentially numbered, beginning with page one. In order to facilitate 
handling, please do not use covers, binders or tabs. Do not include 
extraneous materials as attachments, such as agency promotion 
brochures, slides, tapes, film clips, minutes of meetings, survey 
instruments or articles of incorporation.
    Applicant should include a self-addressed, stamped acknowledgment 
card. All applicants will be notified automatically about the receipt 
of their application. If acknowledgment of receipt of your application 
is not received within eight weeks after the deadline date, please 
notify ACF by telephone at (202) 401-5529.

(Catalog of Federal Domestic Assistance Number 93.671, Family 
Violence Prevention and Services.)

    Dated: March 1, 1995.
Donald Sykes,
Director, Office of Community Services.

                                                 BILLING CODE 4184-01-P
[[Page 12229]]

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BILLING CODE 4184-01-C
[[Page 12230]]

Instructions for the SF 424

    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 a 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 requested.
    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, 
indicate 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 he 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 disallowances, 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 12231]]

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[[Page 12232]]

[GRAPHIC][TIFF OMITTED]TN06MR95.015


BILLING CODE 4184-01-C
[[Page 12233]]

Instructions for the SF-424A

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 functions 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 on 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 totals 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--Enter the estimated amount of income, if any, expected 
to be generated form 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 of 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.

Assurances--Non-Construction Programs

    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 [[Page 12234]] 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 on 
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. 290 dd-3 and 290 ee-3), 
as amended, relating to confidentiality of alcohol and drug abuse 
patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 
U.S.C. Sec. 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 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. Sec. 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. Sec. 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. Sec. 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. 470), EO 11593 (identification and protection of 
historic properties), and the Archaeological and Historic 
Preservation Act of 1974 (16 U.S.C. 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. 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. Sec. 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.
    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 12235]]

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[[Page 12236]]

[GRAPHIC][TIFF OMITTED]TN06MR95.017



BILLING CODE 4184-01-C
[[Page 12237]]

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

    By signing and submitting this proposal, the applicant, defined 
as the primary participant in accordance with 45 CFR Part 76, 
certifies to the best of its knowledge and believe 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 3-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 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 3-year period preceding this application/
proposal had one or more public transactions (Federal, State, or 
local) terminated for cause or default.
    The inability of a person to provide the certification required 
above will not necessarily result in denial of participation in this 
covered transaction. If necessary, the prospective participant shall 
submit an explanation of why it cannot provide the certification. 
The certification or explanation will be considered in connection 
with the Department of Health and Human Services (HHS) 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.
    The prospective primary participant agrees that by submitting 
this proposal, it will include the clause entitled ``Certification 
Regarding Debarment, Suspension, Ineligibility, and Voluntary 
Exclusion--Lower Tier Covered Transaction.'' provided below without 
modification in all lower tier covered transactions and in all 
solicitations for lower tier covered transactions.

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

(To Be Supplied to Lower Tier Participants)

    By signing and submitting this lower tier proposal, the 
prospective lower tier participant, as defined in 45 CFR Part 76, 
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 
participation in this transaction by federal department or agency.
    (b) where the prospective lower tier participant is unable to 
certify to any of the above, such prospective participant shall 
attach an explanation to this proposal.
    The prospective lower tier participant further agrees by 
submitting this proposal that it will include this clause entitled 
``certification Regarding Debarment, Suspension, Ineligibility, and 
Voluntary Exclusion--Lower Tier Covered Transactions.'' without 
modification in all lower tier covered transactions and in all 
solicitations for lower tier covered transactions.

Attachment D--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 any 
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.

State for Loan Guarantee 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

----------------------------------------------------------------------
Organization

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

                                                 BILLING CODE 4184-01-M
[[Page 12238]]

[GRAPHIC][TIFF OMITTED]TN06MR95.018


BILLING CODE 4184-01-C
[[Page 12239]]

Attachment E

Executive Order 12372--State Single Points of Contact

Arizona

Mrs. Janice Dunn, Attn: Arizona State Clearinghouse, 3800 N. Central 
Avenue, 14th Floor, Phoenix, Arizona 85012, Telephone (602) 280-1315

Arkansas

Tracie L. Copeland, Manager, State Clearinghouse, Office of 
Intergovernmental Services, Department of Finance and 
Administration, P.O. Box 3278, Little Rock, Arkansas 72203, 
Telephone (501) 682-1074

California

Glenn Stober, Grants Coordinator, Office of Planning and Research, 
1400 Tenth Street, Sacramento, California 95814, Telephone (916) 
323-7480

Delaware

Ms. Francine Booth, State Single Point of Contact, Executive 
Department, Thomas Collins Building, Dover, Delaware 19903, 
Telephone (303) 736-3326

District of Columbia

Rodney T. Hallman, State Single Point of Contact, Office of Grants 
Management and Development, 717 14th Street, NW., Suite 500, 
Washington, DC. 20005, Telephone (202) 727-6551

Florida

Florida State Clearinghouse, Intergovernmental Affairs Policy Unit, 
Executive Office of the Governor, Office of Planning and Budgeting, 
The Capitol, Tallahassee, Florida 32399-0001, Telephone (904) 488-
8441

Georgia

Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse, 
254 Washington Street, SW., Atlanta, Georgia 30334, Telephone (404) 
656-3855

Illinois

Steve Klokkenga, State Single Point of Contact, Office of the 
Governor, 107 Stratton Building, Springfield, Illinois 62706, 
Telephone (217) 782-1671

Indiana

Jean S. Blackwell, Budget Director, State Budget Agency, 212 State 
House, Indianapolis, Indiana 46204, Telephone (317) 232-5610

Iowa

Mr. Steven R. McCann, Division of Community Progress, Iowa 
Department of Economic Development, 200 East Grand Avenue, Des 
Moines, Iowa 50309, Telephone (515) 281-3725

Kentucky

Ronald W. Cook, Office of the Governor, Department of Local 
Government, 1024 Capitol Center Drive, Frankfort, Kentucky 40601, 
Telephone (502) 564-2382

Maine

Ms. Joyce Bension, State Planning Office, State House Station #38, 
Augusta, Maine 04333, Telephone (207) 289-3261

Maryland

Ms. Mary Abrams, Chief, Maryland State Clearinghouse, Department of 
State Planning, 301 West Preston Street, Baltimore, Maryland 21201-
2365, Telephone (301) 225-4490

Massachusetts

Karen Arone, State Clearinghouse, Executive Office of Communities 
and Development, 100 Cambridge Street, Room 1803, Boston, 
Massachusetts 02202, Telephone (617) 727-7001

Michigan

Richard S. Pastula, Director, Michigan Department of Commerce, 
Lansing, Michigan 48909, Telephone (517) 373-7356

Mississippi

Ms. Cathy Mallette, Clearinghouse Officer, Office of Federal Grant 
Management and Reporting, 301 West Pearl Street, Jackson, 
Mississippi 39203, Telephone (601) 960-2174

Missouri

Ms. Lois Pohl, Federal Assistance Clearinghouse, Office of 
Administration, P.O. Box 809, Room 430, Truman Building, Jefferson 
City, Missouri 65102, Telephone (314) 751-4834

Nevada

Department of Administration, State Clearinghouse, Capitol Complex, 
Carson City, Nevada 89710, Telephone (702) 687-4065, Attention: Ron 
Sparks, Clearinghouse Coordinator

New Hampshire

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

New Jersey

Gregory W. Adkins, Acting Director, Division of Community Resources, 
N.J. Department of Community Affairs, Trenton, New Jersey 08625-
0803, Telephone (609) 292-6613

    Please direct correspondence and questions to:

Andrew J. Jaskolka, State Review Process, Division of Community 
Resources, CN 814, Room 609, Trenton, New Jersey 08625-0803, 
Telephone (609) 292-9025

New Mexico

George Elliott, Deputy Director, State Budget Division, Room 190, 
Bataan Memorial Building, Santa Fe, New Mexico 87503, Telephone 
(505) 827-3640, Fax (505) 827-3006

New York

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

North Carolina

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

North Dakota

N.D. Single Point of Contact, Office of Intergovernmental 
Assistance, Office of Management and Budget, 600 East Boulevard 
Avenue, Bismarck, North Dakota 58505-0170, Telephone (701) 224-2094

Ohio

Larry Weaver, State Single Point of Contact, State/Federal Funds 
Coordinator, State Clearinghouse, Office of Budget and Management, 
30 East Broad Street, 34th Floor, Columbus, Ohio 43266-0411, 
Telephone (614) 466-0698

Rhode Island

Mr. Daniel W. Varin, Associate Director, Statewide Planning Program, 
Department of Administration, Division of Planning, 265 Melrose 
Street, Providence, Rhode Island 02907, Telephone (401) 277-2656

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

Tennessee

Mr. Charles Brown, State Single Point of Contact, State Planning 
Office, 500 Charlotte Avenue, 309 John Sevier Building, Nashville, 
Tennessee 37219, Telephone (615) 741-1676

Texas

Mr. Thomas Adams, Governor's Office of Budget and Planning, P.O. Box 
12428, Austin, Texas 78711, Telephone (512) 463-1778

Utah

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

Vermont

Mr. Bernard D. Johnson, Assistant Director, Office of Policy 
Research and Coordination, Pavilion Office Building, 109 State 
Street, Montpelier, Vermont 05602, Telephone (802) 828-3326

West Virginia

Mr. Fred Cutlip, Director, Community Development Division, West 
Virginia Development Office, Building #6, Room 553, Charleston, West 
Virginia 25305, Telephone (304) 348-4010

Wisconsin

Mr. William C. Carey, Federal/State Relations, Wisconsin Department 
of Administration, 101 South Webster Street, P.O. Box 7864, Madison, 
Wisconsin 53707, Telephone (608) 266-0267

Wyoming

Sheryl Jeffries, State Single Point of Contact, Herschler Building, 
4th Floor, East Wing, Cheyenne, Wyoming 82002, Telephone (307) 777-
7574
[[Page 12240]]

Guam

Mr. Michael J. Reidy, Director, Bureau of Budget and Management 
Research, Office of the Governor, P.O. Box 2950, Agana, Guam 96910, 
Telephone (671) 472-2285

Northern Mariana Islands

State Single Point of Contact, Planning and Budget Office, Office of 
the Governor, Saipan, CM, Northern Mariana Islands 96950

Puerto Rico

Norma Burgos/Jose H. Caro, Chairman/Director, Puerto Rico Planning 
Board, Minillas Government Center, P.O. Box 41119, San Juan, Puerto 
Rico 00940-9985, Telephone (809) 727-4444

Virgin Islands

Jose L. George, Director, Office of Management and Budget, #41 
Norregade Emancipation Garden Station, Second Floor, Saint Thomas, 
Virgin Islands 00802

    Please direct correspondence to:

Linda Clarke, Telephone (809) 774-0750

Attachment F

Certification Regarding Environmental Tobacco Smoke

    Public Law 103-227, Part C--Environmental Tobacco Smoke, also 
known as the Pro-Children Act of 1994 (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 loan 
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 the law may 
result in the imposition 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.

[FR Doc. 95-5409 Filed 3-3-95; 8:45 am]
BILLING CODE 4184-01-P