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Timestamp: 2018-03-20 03:03:58
Document Index: 638731006

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description: tags: 2005-326g | No Child Left Behind Act | Educational Assessment
description: tags: 2005-326g
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(CFDA 84.326G)
DATED MATERIAL - OPEN IMMEDIATELY CLOSING DATE: September 7, 2005
Technical Assistance and Dissemination to Improve Services and Results for Children with Disabilities National Technical Assistance Center on Assessment for Children with Disabilities (CFDA No. 84.326G) …………………………………………………………………….…B2 Selection Criteria and Format for 84.326G............................................…............……….….B9
General Information on Completing an Application ..........................................………………...C1 Application Transmittal Instructions and Requirements for Intergovernmental Review (Executive Order 12372). .................................................................……………………D1 Notice to All Applicants (Ensuring Equitable Access) and Application Forms and Instructions.............................................................................…………………….….E1 Part I: Application for Federal Assistance (ED Form 424) Part II: Budget Information -- Non-Construction Programs and Instructions (ED Form 524) Part III: Application Narrative Part IV: Assurances and Certifications Assurances -- Non-Construction Program Certifications Regarding Lobbying; Debarment, Suspension, and Other Responsibility Matters; and Drug-Free Workplace Requirements (ED Form 80-0013) Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered Transactions (ED Form 80-0014) Disclosure of Lobbying Activities Survey on Ensuring Equal Opportunity for Applicants Notice to All Applicants: The Government Performance and Results Act (GPRA)
Dear Applicant: This application packet contains information and the required forms for you to use in submitting a new application for funding under one program authorized by the Individuals with Disabilities Education Act (IDEA). This packet covers one competition under the Technical Assistance and Dissemination to Improve Services and Results for Children with Disabilities (CFDA 84.326) program--National Technical Assistance Center on Assessment for Children with Disabilities (CFDA No. 84.326G). An application for an award must be: (1) hand-delivered, submitted electronically, or mailed by the closing date; and, (2) for paper applications, have an original signature on at least one copy of the assurances and certifications (Part IV of the application form). It is also important to include the appropriate Catalog of Federal Domestic Assistance (CFDA) numeric and alpha in Item #4 on ED Form 424 (e.g., CFDA No. 84.326G) for paper applications.
Please note the following: • APPLICATION SUBMISSION. Based on the precautionary procedures the U.S. Postal Service is using to process mail, we are experiencing delays in the delivery of mail to the Department. Therefore, you may want to consider sending your application by overnight courier or submitting your application electronically. GRANTS.GOV APPLICATION SUBMISSION. Applications for grants under this competition may be submitted electronically using the Grants.gov Apply site (www.Grants.gov). Please read carefully the document that we have included immediately following this letter (see page A-4), which includes helpful tips about submitting electronically using the Grants.gov Apply site. Please note that you must follow the Application Procedures as described in the Federal Register notice announcing this grant competition. Information (including dates and times) about how to submit your application electronically, or by mail or hand delivery, can also be found in section E-1 Application Transmittal Instructions and Requirements for Intergovernmental Review of this application package. MAXIMUM AWARD AMOUNT. In addition to providing detailed budget information for the total grant period requested, the competition included in this package has a maximum award amount (See Page B-3 of this package). Please be advised that for the priority in this package, the maximum award amount covers all project costs including indirect costs. STRICT PAGE LIMITS. The competition included in this package limits the Part III Application Narrative to a specified number of double-spaced pages. This page limitation applies to all material presented in the application narrative -- including, for example, any
charts, tables, figures, and graphs. (Please refer to the specific requirements on page limits for the priority/competition to which you are submitting an application - i.e., Section B-4 of this package). The Department will reject, and will NOT consider an application that does not adhere to the page limit requirements for the competition. • FORMAT FOR APPLICATIONS. Please note that additional information regarding formatting applications has been included on Pages C-3 and 4 of the “General Information on Completing An Application” section of this package. PROTECTION OF HUMAN SUBJECTS IN RESEARCH. The discretionary grant Application Form 424 (ED supplement to the SF 424 on Grants.gov) requires applicants to indicate whether they plan to conduct research involving human subjects at any time during the proposed project period. The Protection of Human Subjects in Research Attachment is an integral part of the ED 424 form (ED supplement to the SF 424 on Grants.gov). It includes information that applicants need to complete the protection of human subjects item and, as appropriate, to provide additional information to the Department regarding human subjects research projects. Additional information on completing the protection of human subjects item is also available and can be accessed on the INTERNET at: http://www.ed.gov/about/offices/list/ocfo/gcsindex.html http://www.ed.gov/about/offices/list/ocfo/humansub.html • RESPONSE TO GPRA. As required by the Government Performance and Results Act (GPRA) of 1993 OSEP has developed a strategic plan for measuring GPRA performance. The program included in this announcement is authorized under Part D - National Activities to Improve Education of Children with Disabilities of the Individuals with Disabilities Education Act. The Office of Special Education Programs (OSEP) will collect information to assess progress and performance. See Performance Measures included in the Priority Description section of this application package. Applicants are encouraged to consider this information, as applications are prepared. COPIES OF THE APPLICATION. Current Government-wide policy requires that an original and two copies need to be submitted. OSEP would appreciate receiving three additional copies to facilitate the peer review process. This means an original and two copies are required but we would appreciate your voluntarily submitting an additional three copies (six applications in all). If you are submitting your application electronically, you do not need to submit paper copies of the application. Please note: If an application is recommended for funding and a grant award is issued, we will contact the applicant to request a copy of the application on a diskette or CD. The Department is moving toward an electronic grant filing system and an electronic copy of all applications that are being funded will facilitate this effort.
DEADLINE: 09/07/05 ABSOLUTE PRIORITY: Background of Priority: Federal and State education policies, including those based on the No Child Left Behind Act of 2001 (NCLB), call for the inclusion of students with disabilities in assessment and accountability programs in order to improve educational results for these students. A series of recent Federal policies and initiatives are expected to enhance the inclusion of students with disabilities in assessments and accountability. Among these are the Department’s regulations in 34 CFR part 200 permitting alternate assessments based on alternate achievement standards for students with the most significant cognitive disabilities. In addition, on April 7, 2005, the Secretary announced the intent to provide additional flexibility that will allow States to develop modified academic achievement standards and use alternate assessments based on these modified achievement standards for students served under the IDEA who do not have the most significant cognitive disabilities, but who are not able to participate in the regular assessment, even with accommodations. The Department is also preparing a “Tool Kit” with information to help States improve instruction and assessments for students with disabilities. On June 3, 2005, the Department announced in the Federal Register (70 FR 32583) a competition to support Comprehensive Regional and Content Centers that will focus on helping States to implement NCLB and to build their capacity to assist LEAs and schools in implementing NCLB. The Content Centers, one of which will focus specifically on assessments and accountability, are intended to work primarily through the Regional Centers in providing technical assistance. Statement of Priority: This priority supports one cooperative agreement for a Center to provide technical assistance on improving results for students with disabilities by increasing their participation rates in high quality assessment and accountability systems, improving the quality of assessments in which they participate, improving the capacity of States to meet data collection requirements, and strengthening accountability for results. The Center must accomplish this mission through a combination of activities in the following areas: (1) needs assessments and information gathering, (2) technical assistance and dissemination to improve the participation of students with disabilities in assessments and accountability systems, (3) technical assistance to improve the capacity of States to meet data collection requirements, (4) collaboration and leadership, and (5) other functions. Activity Area (1): The Center's needs assessments and information gathering activities must include, but are not limited to:
(a) Conducting surveys of States and other entities to determine the status of the implementation of assessment and accountability policies related to students with disabilities; (b) Analyzing State-reported assessment data to track the participation and performance of students with disabilities in large-scale assessments; (c) Analyzing State and local policies and practices to determine the best approaches to improve the participation of students with disabilities in assessment and accountability systems; (d) Synthesizing research information on relevant topics such as assessment accommodations, alternate assessments, data analysis and reporting, and other related areas; and (e) Collecting research and technical information from the Technical Workgroup on Large Scale Assessment for Children with Disabilities, the National Alternate Assessment Center, the Research Institute on Progress Monitoring, research projects funded under the Research on Accessible Reading Assessments competition, and other federally funded projects as appropriate. Activity Area (2): The Center's technical assistance and dissemination activities to improve the participation of students with disabilities in high-quality assessments and accountability systems must include, but are not limited to: (a) Preparing and disseminating reports and documents on research findings and related topics; (b) Maintaining a Web site with relevant information and documents in a format that meets a government or industry-recognized standard for accessibility; (c) Conducting national and regional meetings and teleconferences, in collaboration with other centers such as the Federal and Regional Resource Centers and the Comprehensive Regional and Content Centers, to assist SEAs and LEAs and other relevant audiences in continuing the implementation of assessment and accountability policies for students with disabilities; (d) Working directly with States and other stakeholders in collaboration with the Comprehensive Regional and Content Centers to increase the participation of students with disabilities in State and local assessment and accountability systems, and improve the quality of assessment procedures; (e) Disseminating information to specific audiences, including teachers, families, administrators, policymakers and researchers, in collaboration with other technical assistance providers, organizations, and researchers; and (f) Collaborating with the Comprehensive Content Centers, particularly the Center on Assessment and Accountability, to assist the Comprehensive Regional Centers in providing
technical assistance to States by supplying them with research-based information, products, guidance, analyses, and tools. Activity Area (3): The Center’s technical assistance activities to improve the capacity of States to meet data collection requirements must include, but are not limited to: (a) Conducting needs assessments and analyzing State reports to evaluate the capacity of States to collect data on the participation and performance of students with disabilities on largescale assessments and to identify areas requiring technical assistance; (b) Collecting information on best practices for State data collection; (c) Developing technical assistance materials and resources that can be used to evaluate and improve the capacity of States to collect data on the participation and performance of students with disabilities on large-scale assessments; and (d) Delivering and evaluating technical assistance to States to improve their capacity to collect data on the participation and performance of students with disabilities on large-scale assessments. Specific attention must be given to States engaged in large-scale assessment planning or implementation projects funded under the Office of Special Education Programs’ (OSEP) General Supervision Enhancement Grant (GSEG) competition. Activity Area (4): The Center's collaboration and leadership activities must include, but are not limited to: (a) Participating in a community or communities of practice related to the Center's mission. The community or communities may include research experts, other federally funded projects (such as the Regional Resource Centers, the Federal Resource Center, the Center to Improve Access to the General Education Curriculum for Students with Disabilities at the Elementary and Middle School Levels, and the Comprehensive Regional and Content Centers), professional organizations (such as the National Association of State Directors of Special Education, the Council for Exceptional Children, and the Council of Chief State School Officers), and other projects and organizations (such as organizations representing parents or disability organizations); and (b) Convening topical meetings, at the request of OSEP, to study issues and develop proactive recommendations for addressing challenges related to the participation of students with disabilities in assessment and accountability systems. Activity Area (5): The Center must also: (a) Develop a strategic plan and submit it to OSEP for review and approval. The plan must include, among other things, how the Center will collaborate with other Department of Education technical assistance centers, including the Comprehensive Regional and Content Centers. The plan must be revised and approved periodically as needed;
(b) Establish, maintain, and meet at least annually with a technical work group (TWG) to ensure that the highest standards of scientific rigor are maintained in the Center’s work. Members of this TWG must be approved by OSEP and must include membership from the Technical Workgroup on Large Scale Assessment for Children with Disabilities and other research experts in the areas of large scale assessments, instructional improvement and reform, and instruction for students with disabilities; (c) Establish, maintain, and meet at least annually with an advisory committee consisting of representatives of SEAs and LEAs, individuals with disabilities, parents, educators, professional organizations, advocacy groups, researchers, and other appropriate groups to review and advise on the Center's activities, accomplishments, and strategic plan. The committee must include membership that represents urban schools and underrepresented populations; (d) Budget for three annual two-day meetings in Washington, DC to attend two Project Directors' meetings and an OSEP Leadership Conference; and (e) Budget for at least one trip monthly to attend meetings organized by projects and organizations such as the Assessing Special Education Students State Collaborative on Assessment and Student Standards (ASES SCASS), the National Association of State Directors of Special Education, and Federal offices, on topics relevant to the Center's mission. In deciding whether to continue this project for the fourth and fifth years, the Secretary will consider the requirements of 34 CFR 75.253(a), and in addition-(a) The recommendation of a review team consisting of experts selected by the Secretary. The review will be conducted in Washington, DC during the last half of the project's second year. Applicants must budget for the travel associated with this one-day intensive review; (b) The timeliness and effectiveness with which all requirements of the negotiated cooperative agreement have been or are being met by the Center; and (c) The degree to which the Center is making a positive contribution to the participation of students with disabilities in State and local assessment and accountability systems. PROGRAM AUTHORITY: 20 U.S.C. 1463 and 1481(d). PERFORMANCE MEASURES: Under the Government Performance and Results Act (GPRA), the Department is currently developing measures that will yield information on various aspects of the quality of the Technical Assistance to Improve Services and Results for Children with Disabilities program. The measures will focus on: the extent to which projects provide high quality products and services; the relevance of project products and services to educational and early intervention policy and practice; and the use of products and services to improve educational and early intervention policy and practice. Once the measures are developed, we will notify grantees if they will be required to provide any information related to these measures.
Grantees will also be required to report information on their projects’ performance in annual reports to the Department (34 CFR 75.590). APPLICATIONS AVAILABLE: August 8, 2005. DEADLINE FOR TRANSMITTAL OF APPLICATIONS: September 7, 2005. DEADLINE FOR INTERGOVERNMENTAL REVIEW: September 19, 2005. ESTIMATED AVAILABLE FUNDS: $1,000,000. ESTIMATED AVERAGE SIZE OF AWARDS: $1,000,000. MAXIMUM AWARDS: The Secretary does not intend to fund an application that proposes a budget exceeding $1,000,000 for a single budget period of 12 months. ESTIMATED NUMBER OF AWARDS: 1. Note: The Department is not bound by any estimates in this notice. PROJECT PERIOD: Up to 60 months. PAGE LIMITS: If you are an applicant, Part III of an application submitted under this notice, the application narrative, is where an applicant addresses the selection criteria that are used by reviewers to evaluate the application. You must limit Part III to the equivalent of no more than 70 pages, using the following standards: • • A "page" is 8.5" x 11", (on one side only) with 1” margins (top, bottom, and sides). Double-space (no more than three lines per vertical inch) all text in the application narrative, including titles, headings, footnotes, quotations, references, and captions, as well as all text in charts, tables, figures, and graphs.
GENERAL REQUIREMENTS: (a) Projects funded under this notice must make positive efforts to employ and advance in employment qualified individuals with disabilities in project activities (see section 606 of IDEA); and (b) Applicants and grant recipients funded under this notice must involve individuals with disabilities or parents of individuals with disabilities in planning, implementing, and evaluating the projects (see section 682(a)(1)(A) of IDEA). APPLICABLE REGULATIONS: (a) The Education Department General Administrative Regulations (EDGAR) in 34 CFR parts 74, 75, 77, 79, 80, 81, 82, 84, 85, 86, 97, 98, and 99; and (b) The selection criteria for this program are drawn from EDGAR in 34 CFR 75.210. Note: The regulations in 34 CFR part 79 apply to all applicants except federally recognized Indian tribes. Note: The regulations in 34 CFR part 86 apply to institutions of higher education only. ELIGIBLE APPLICANTS: State educational agencies (SEAs), local educational agencies (LEAs), public charter schools that are LEAs under State law, institutions of higher education (IHEs), other public agencies, private nonprofit organizations, outlying areas, freely associated States, Indian tribes or tribal organizations, and for-profit organizations. INTERGOVERNMENTAL REVIEW: The program in this notice is subject to the requirements of Executive Order 12372 and the regulations in 34 CFR part 79. One of the objectives of the Executive Order is to foster an intergovernmental partnership and a strengthened federalism. The Executive order relies on processes developed by State and local governments for coordination and review of proposed Federal financial assistance. This document provides early notification of our specific plans and actions for this program.
For further information about this priority contact: David Egnor, Competition Manager Research to Practice Division Office of Special Education Programs Telephone: (202) 245-7334 FAX: (202) 245-7615 Internet: David.Egnor@ed.gov TTD: 1-800-877-8339
SELECTION CRITERIA AND FORMAT FOR THE NATIONAL TECHNICAL ASSISTANCE CENTER ON ASSESSMENT FOR CHILDREN WITH DISABILITIES (CFDA 84.326G) COMPETITION Part III of the application form requires a narrative that addresses the selection criteria that will be used by reviewers in evaluating individual proposals. Applications are more likely to receive favorable reviews by panels when they are organized according to the format suggested below. This format was published in the FEDERAL REGISTER as an appendix to the program regulations, and it addresses all the selection criteria used to evaluate applications required by regulations. If you prefer to use a different format, you may wish to cross-reference the sections of your application to the selection criteria to be sure that reviewers are able to find all relevant information. The selection criteria that will be used to evaluate applications submitted to the National Technical Assistance Center on Assessment for Children with Disabilities (CFDA 84.326G) competition are the selection criteria for new grants required by the EDGAR general selection criteria menu. The maximum score for all of the criteria is 100 points. A one-page abstract should precede the application narrative. The application narrative should include the following sections in this order: (a) Significance (15 points) (1) The Secretary considers the significance of the proposed project. (2) In determining the significance of the proposed project, the Secretary considers the following factors: (i) The potential contribution of the proposed project to increased knowledge or understanding of educational problems, issues, or effective strategies; (ii) The likelihood that the proposed project will result in system change or improvement; (iii) The extent to which the proposed project is likely to build local capacity to provide, improve, or expand services that address the needs of the target population; (iv) The likely utility of the products (such as information, materials, processes, or techniques) that will result from the proposed project, including the potential for their being used effectively in a variety of other settings; and (v) The importance or magnitude of the results or outcomes likely to be attained by the proposed project. (b) Quality of project services (30 points)
(1) The Secretary considers the quality of the services to be provided by the proposed project. (2) In determining the quality of the services to be provided by the proposed project, the Secretary considers the quality and sufficiency of strategies for ensuring equal access and treatment for eligible project participants who are members of groups that have traditionally been underrepresented based on race, color, national origin, gender, age, or disability. (3) In addition, the Secretary considers the following factors: (i) The extent to which the services to be provided by the proposed project are appropriate to the needs of the intended recipients or beneficiaries of those services; (ii) The extent to which entities that are to be served by the proposed technical assistance project demonstrate support for the project; (iii) The extent to which the services to be provided by the proposed project reflect up-to-date knowledge from research and effective practice; (iv) The likely impact of the services to be provided by the proposed project on the intended recipients of those services; (v) The extent to which the services to be provided by the proposed project involve the collaboration of appropriate partners for maximizing the effectiveness of project services; and (vi) The extent to which the technical assistance services to be provided by the proposed project involve the use of efficient strategies, including the use of technology, as appropriate, and the leveraging of non-project resources. (c) Quality of project personnel (20 points) (1) The Secretary considers the quality of the personnel who will carry out the proposed project. (2) In determining the quality of project personnel, the Secretary considers the extent to which the applicant encourages applications for employment from persons who are members of groups that have traditionally been underrepresented based on race, color, national origin, gender, age, or disability. (3) In addition, the Secretary considers the following factors: (i) The qualifications, including relevant training and experience, of key project personnel; and (ii) The qualifications, including relevant training and experience, of project consultants or subcontractors.
• SUBMISSION TO MORE THAN ONE PROGRAM Applications may be submitted to more than one Federal program if you are unsure of the most appropriate program. Each application should be prepared following the instructions for that particular program as closely as possible (which may require some reformulation). It is very helpful if each program is notified that an identical or similar application is being submitted to another program. • HELP PREPARING APPLICATIONS We are happy to provide general program information. Clearly it would not be appropriate for staff to participate in the actual writing of an application, but we can respond to specific questions about our application requirements and evaluation criteria, or about the announced priorities. Applicants should understand that such previous contact is not required, nor does it guarantee the success of an application. • NOTIFICATION OF FUNDING The time required to complete the evaluation of applications is variable. Once applications have been received staff must determine the areas of expertise needed to appropriately evaluate the applications, identify and contact potential reviewers, convene peer review panels, and summarize and review the recommendations of the review panels. You can expect to receive notification within 3 to 6 months of the application closing date, depending on the number of applications received and the number of competitions with closing dates at about the same time. The requested start date can be no later than January 1 of the year following the closing date of the competition. • POSSIBILITY OF LEARNING THE OUTCOME OF REVIEW PANELS PRIOR TO OFFICIAL NOTIFICATION Every year we are called by a number of applicants who have legitimate reasons for needing to know the outcome of the review prior to official notification. Some applicants need to make job decisions, some need to notify a local school district, etc. Regardless of the reason, we cannot share information about the review with anyone until the Assistant Secretary has approved a slate of projects recommended for funding. You will be notified as quickly as possible either by telephone (if your application is recommended for funding), or through a letter (if your application is not successful). • FORMAT FOR APPLICATIONS The application narrative (Part III of the application form) should be organized to follow the exact sequence of the components in the selection criteria used to evaluate applications. (The selection criteria for the competitions covered by this packet are listed following the specific competition information in section “B” of this packet.) A table of contents, list of priority requirements, and a one-page abstract summarizing the objectives, activities, project participants, and expected outcomes of the proposed project should precede the application narrative. If you prefer to use a different format, you may wish to cross-reference the sections of your application to the selection criteria to be sure that reviewers are able to find all relevant information.
BEST WAY TO PREPARE PROGRAM ABSTRACT The program abstract should be one page in length. It would be helpful if it included; the title of the program, the name of the Absolute Priority, and the CFDA Number (e.g., 84.326G, etc.).
MAKING SURE APPLICATION IS ASSIGNED TO THE CORRECT COMPETITION Applicants should clearly indicate in Item 3 on the application (ED Form 424) the CFDA number of the program priority (e.g., 84.326G, etc.) representing the competition in which the application should be considered. If this information is not provided, your application may inadvertently be assigned and reviewed under a different competition from the one you intended.
Application Transmittal Instructions ATTENTION ELECTRONIC APPLICANTS: Please note that you must follow the Application Procedures as described in the Federal Register notice announcing the grant competition. Some programs may require electronic submission of applications, and those programs will have specific requirements and waiver instructions in the Federal Register notice. If you want to apply for a grant and be considered for funding, you must meet the following deadline requirements: Applications Submitted Electronically You must submit your grant application through the Internet using the software provided on the Grants.gov Web site (http://www.grants.gov) by 4:30 p.m. (Washington, DC time) on the application deadline date. If you submit your application through the Internet via the e-Grants Web site, you will receive an automatic acknowledgment when we receive your application. For more information on using Grants.gov, please refer to the Notice Inviting Applications that was published in the Federal Register, the Grants.gov Submission Procedures and Tips document found in the application package instructions, and visit http://www.grants.gov. Applications Sent by Mail You must mail the original and two copies of the application on or before the deadline date to. To help expedite our review of your application, we would appreciate your voluntarily including an additional 3 copies of your application. Please mail copies to: U.S. Department of Education Application Control Center Attention: CFDA# 84.326G 400 Maryland Avenue, SW Washington, DC 20202 - 4260 You must show one of the following as proof of mailing: (1)A legibly dated U. S. Postal Service Postmark. (2)A legible mail receipt with the date of mailing stamped by the U. S. Postal Service. (3)A dated shipping label, invoice, or receipt from a commercial carrier. (4)Any other proof of mailing acceptable to the Secretary. If you mail an application through the U.S. Postal Service, we do not accept either of the following as proof of mailing: D-1
(1) A private metered postmark. (2) A mail receipt that is not dated by the U.S. Postal Services. An applicant should note that the U.S. Postal Service does not uniformly provide a dated postmark. Before relying on this method, an applicant should check with its local post office. Applications Delivered by Commercial Carrier: Special Note: Due to recent disruptions to normal mail delivery, the Department encourages you to consider using an alternative delivery method (for example, a commercial carrier, such as Federal Express or United Parcel Service; or U. S. Postal Service Express Mail) to transmit your application for this competition to the Department. If you use an alternative delivery method, please obtain the appropriate proof of mailing under “Applications Sent by Mail,” then follow the mailing instructions under the appropriate delivery method. Applications that are delivered by commercial carrier, such as Federal Express, United Parcel Service, etc. should be mailed to the: U.S. Department of Education Application Control Center – Stop 4260 Attention: CFDA# 84.326G 7100 Old Landover Road Landover, MD 20785-1506 Applications Delivered by Hand You or your courier must hand deliver the original and number of copies requested of the application by 4:30 p.m. (Washington, DC time) on or before the deadline date. To help expedite our review of your application, we would appreciate your voluntarily including an additional 3 copies of your application. Please hand deliver copies to: U.S. Department of Education Application Control Center Attention: CFDA# 84.326G 550 12th Street, SW PCP - Room 7041 Washington, DC 20202 – 4260 The Application Control Center accepts application deliveries daily between 8:00 a.m. and 4:30 p.m. (Washington, DC time), except Saturdays, Sundays and Federal holidays. D-2
STATE SINGLE POINTS OF CONTACT (SPOCs) It is estimated that in 2004 the Federal Government will outlay $400 billion in grants to State and local governments. Executive Order 12372, "Intergovernmental Review of Federal Programs," was issued with the desire to foster the intergovernmental partnership and strengthen federalism by relying on State and local processes for the coordination and review of proposed Federal financial assistance and direct Federal development. The Order allows each State to designate an entity to perform this function. Below is the official list of those entities. For those States that have a home page for their designated entity, a direct link has been provided on the official version: http://www.whitehouse.gov/omb/grants/spoc.html. States that are not listed on this page have chosen not to participate in the intergovernmental review process, and therefore do not have a SPOC. If you are located within one of these States, you may still send application materials directly to a Federal awarding agency. Contact information for Federal agencies that award grants can be found in The Catalog of Federal Domestic Assistance Catalog Contents Page. You can access Appendix IV by Agency [http://12.46.245.173/CFDA/appx4_web.pdf] or by State [http://12.46.245.173/CFDA/appx4_web_state.pdf]. ARKANSAS Tracy L. Copeland Manager, State Clearinghouse Office of Intergovernmental Services Department of Finance and Administration 1515 W. 7th Street, Room 412 Little Rock, Arkansas 72203 Telephone: (501) 682-1074 FAX: (501) 682-5206 tracy.copeland@dfa.state.ar.us DELAWARE Sandra R. Stump Executive Department Office of the Budget 540 S. Dupont Highway , 3rd Floor Dover, Delaware 19901 Telephone: (302) 739-3323 FAX: (302) 739-5661 sandy.stump@state.de.us FLORIDA Lauren P. Milligan Florida State Clearinghouse Florida Dept. of Environmental Protection 3900 Commonwealth Boulevard Mall Station 47 Tallahassee, Florida 32399-3000 Telephone: (850) 245-2161 FAX: (850) 245-2190 Lauren.Milligan@dep.state.fl.us CALIFORNIA Grants Coordination State Clearinghouse Office of Planning and Research P.O. Box 3044, Room 222 Sacramento, California 95812-3044 Telephone: (916) 445-0613 FAX: (916) 323-3018 State.clearinghouse@opr.ca.gov DISTRICT OF COLUMBIA Marlene Jefferson DC Government Office of Partnerships and Grants Development 414 4th Street, NW Washington, DC 20001 Telephone: (202) 727-6518 FAX: (202) 727-1652 marlene.Jefferson@dc.gov GEORGIA Barbara Jackson Georgia State Clearinghouse 270 Washington Street, SW, 8th Floor Atlanta, Georgia 30334 Telephone: (404) 656-3855 FAX: (404) 656-7901 gach@mail.opb.state.ga.us
NEVADA Michael Stafford Department of Administration State Clearinghouse 209 E. Musser Street, Room 200 Carson City, Nevada 89701 Telephone: (775) 684-0209 FAX: (775) 684-0260 mstafford@budget.state.nv.us NEW YORK Linda Shkrell Office of Public Security Homeland Security Grants Coordination 633 3rd Avenue New York, NY 10017 Telephone: (212) 867-1289 FAX: (212) 867-1725 RHODE ISLAND Joyce Karger Department of Administration One Capitol Hill Providence Rhode Island 02908-5870 Telephone: (401) 222-6181 FAX: (401) 222-2083 jkarger@doa.state.ri.us TEXAS Denise S. Francis Director, State Grants Team Governor’s Office of Budget and Planning P.O. Box 12428 Austin, Texas 78711 Telephone: (512) 305-9415 FAX: (512) 936-2681 dfrancis@governor.state.tx.us
OMB Control No. 1890-0007 (Exp. 11/30/2007) NOTICE TO ALL APPLICANTS The purpose of this enclosure is to inform you about a new provision in the Department of Education's General Education Provisions Act (GEPA) that applies to applicants for new grant awards under Department programs. This provision is Section 427 of GEPA, enacted as part of the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382). To Whom Does This Provision Apply? Section 427 of GEPA affects applicants for new grant awards under this program. ALL APPLICANTS FOR NEW AWARDS MUST INCLUDE INFORMATION IN THEIR APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER TO RECEIVE FUNDING UNDER THIS PROGRAM. (If this program is a State-formula grant program, a State needs to provide this description only for projects or activities that it carries out with funds reserved for State-level uses. In addition, local school districts or other eligible applicants that apply to the State for funding need to provide this description in their applications to the State for funding. The State would be responsible for ensuring that the school district or other local entity has submitted a sufficient section 427 statement as described below.) What Does This Provision Require? Section 427 requires each applicant for funds (other than an individual person) to include in its application a description of the steps the applicant proposes to take to ensure equitable access to, and participation in, its Federally-assisted program for students, teachers, and other program beneficiaries with special needs. This provision allows applicants discretion in developing the required description. The statute highlights six types of barriers that can impede equitable access or participation: gender, race, national origin, color, disability, or age. Based on local circumstances, you should determine whether these or other barriers may prevent your students, teachers, etc. from such access or participation in, the Federally-funded project or activity. The description in your application of steps to be taken to overcome these barriers need not be lengthy; you may provide a clear and succinct description of how you plan to address those barriers that are applicable to your circumstances. In addition, the information may be provided in a single narrative, or, if appropriate, may be discussed in connection with related topics in the application. Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to ensure that, in designing their projects, applicants for Federal funds address equity concerns that may affect the ability of certain potential beneficiaries to fully participate in the project and to achieve to high standards. Consistent with program requirements and its approved application, an applicant may use the Federal funds awarded to it to eliminate barriers it identifies. What are Examples of How an Applicant Might Satisfy the Requirement of This Provision? The following examples may help illustrate how an applicant may comply with Section 427. (1) An applicant that proposes to carry out an adult literacy project serving, among others, adults with limited English proficiency, might describe in its application how it intends to distribute a brochure about the proposed project to such potential participants in their native language. (2) An applicant that proposes to develop instructional materials for classroom use might describe how it will make the materials available on audio tape or in braille for students who are blind. (3) An applicant that proposes to carry out a model science program for secondary students and is concerned that girls may be less likely than boys to enroll in the course, might indicate how it intends to conduct "outreach" efforts to girls, to encourage their enrollment. We recognize that many applicants may already be implementing effective steps to ensure equity of access and participation in their grant programs, and we appreciate your cooperation in responding to the requirements of this provision.
The application is divided into four parts. These parts are organized in the same manner that the submitted application should be organized. These parts are as follows: Part I: Application for Federal Education Assistance (ED 424) and Instructions. Part II: Budget Information -- Non-Construction Programs (ED Form 524) and Instructions. Part III: Application Narrative. Part IV: Assurances and Certifications -Assurances -- Non-Construction Programs (Standard Form 424B). Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and Drug-Free Workplace Requirements (ED Form 80-0013). Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered Transactions (ED Form 80-0014) and Instructions. Disclosure of Lobbying Activities. An applicant may submit information on a photostatic copy of the application and budget forms, the assurances, and the certifications. However, the application form, the assurances, and the certifications must each have an original signature. No grant may be awarded unless a completed application form has been received.
1. Legal Name and Address. Enter the legal name of applicant and the name of the primary organizational unit which will undertake the assistance activity. D-U-N-S Number. Enter the applicant’s D-U-N-S Number. If your organization does not have a D-U-NS Number, you can obtain the number by calling 1800-333-0505 or by completing a D-U-N-S Number Request Form. The form can be obtained via the Internet at the following URL: http://www.dnb.com. Tax Identification Number. Enter the taxpayer’s identification number as assigned by the Internal Revenue Service. Catalog of Federal Domestic Assistance (CFDA) Number. Enter the CFDA number and title of the program under which assistance is requested. The CFDA number can be found in the federal register notice and the application package. Project Director. Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on matters involving this application. Novice Applicant. Check “Yes” or “No” only if assistance is being requested under a program that gives special consideration to novice applicants. Otherwise, leave blank. Check “Yes” if you meet the requirements for novice applicants specified in the regulations in 34 CFR 75.225 and included on the attached page entitled “Definitions for Form ED 424.” By checking “Yes” the applicant certifies that it meets these novice applicant requirements. Check “No” if you do not meet the requirements for novice applicants. 7. Federal Debt Delinquency. Check “Yes” if the applicant’s organization is delinquent on any Federal debt. (This question refers to the applicant’s organization and not to the person who signs as the authorized representative. Categories of debt include delinquent audit disallowances, loans and taxes.) Otherwise, check “No.” Type of Applicant. Enter the appropriate letter in the box provided. State Application Identifier. State use only (if applicable). subject to review by E.O. 12372. Also, please enter the month, day, and four (4) digit year (mm/dd/yyyy). Otherwise, check “No.” 12. Proposed Project Dates. Please enter the month, day, and four (4) digit year (mm/dd/yyyy). 13. Human Subjects Research. (See I.A. “Definitions” in attached page entitled “Definitions for Form ED 424.”) If Not Human Subjects Research. Check “No” if research activities involving human subjects are not planned at any time during the proposed project period. The remaining parts of Item 12 are then not applicable. If Human Subjects Research. Check “Yes” if research activities involving human subjects are planned at any time during the proposed project period, either at the applicant organization or at any other performance site or collaborating institution. Check “Yes” even if the research is exempt from the regulations for the protection of human subjects. (See I.B. “Exemptions” in attached page entitled “Definitions for Form ED 424.”) 13a. If Human Subjects Research is Exempt from the Human Subjects Regulations. Check “Yes” if all the research activities proposed are designated to be exempt from the regulations. Insert the exemption number(s) corresponding to one or more of the six exemption categories listed in I.B. “Exemptions.” In addition, follow the instructions in II.A. “Exempt Research Narrative” in the attached page entitled “Definitions for Form ED 424.” Insert this narrative immediately following the ED 424 face page. 13a. If Human Subjects Research is Not Exempt from Human Subjects Regulations. Check “No” if some or all of the planned research activities are covered (not exempt). In addition, follow the instructions in II.B. “Nonexempt Research Narrative” in the page entitled “Definitions for Form ED 424.” Insert this narrative immediately following the ED 424 face page. 13a. Human Subjects Assurance Number. If the applicant has an approved Federal Wide (FWA) or Multiple Project Assurance (MPA) with the Office for Human Research Protections (OHRP), U.S. Department of Health and Human Services, that covers the specific activity, insert the number in the space provided. If the applicant does not have an approved assurance on file with OHRP, enter “None.” In this case, the applicant, by signature on the face page, is declaring that it will comply with 34 CFR 97 and proceed to obtain the human subjects assurance upon request by the designated ED official. If the
application is recommended/selected for funding, the designated ED official will request that the applicant obtain the assurance within 30 days after the specific formal request. Note about Institutional Review Board Approval. ED does not require certification of Institutional Review Board approval with the application. However, if an application that involves non-exempt human subjects research is recommended/selected for funding, the designated ED official will request that the applicant obtain and send the certification to ED within 30 days after the formal request. 14. Project Title. 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.
Definitions for Form ED 424 Novice Applicant (See 34 CFR 75.225). For discretionary grant programs under which the Secretary gives special consideration to novice applications, a novice applicant means any applicant for a grant from ED that— • • Has never received a grant or subgrant under the program from which it seeks funding; Has never been a member of a group application, submitted in accordance with 34 CFR 75.127-75.129, that received a grant under the program from which it seeks funding; and Has not had an active discretionary grant from the Federal government in the five years before the deadline date for applications under the program. For the purposes of this requirement, a grant is active until the end of the grant’s project or funding period, including any extensions of those periods that extend the grantee’s authority to obligate funds. Executive Order 12372. The purpose of Executive Order 12372 is to foster an intergovernmental partnership and strengthen federalism by relying on State and local processes for the coordination and review of proposed Federal financial assistance and direct Federal development. The application notice, as published in the Federal Register, informs the applicant as to whether the program is subject to the requirements of E.O. 12372. In addition, the application package contains information on the State Single Point of Contact. An applicant is still eligible to apply for a grant or grants even if its respective State, Territory, Commonwealth, etc. does not have a State Single Point of Contact. For additional information on E.O. 12372 go to http://12.46.245.173/pls/portal30/catalog.REQ_FOR_ 12372.show PROTECTION OF HUMAN SUBJECTS IN RESEARCH I. Definitions and Exemptions A. Definitions. A research activity involves human subjects if the activity is research, as defined in the Department’s regulations, and the research activity will involve use of human subjects, as defined in the regulations. —Research The ED Regulations for the Protection of Human Subjects, Title 34, Code of Federal Regulations, Part 97, define research as “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge.” If an activity follows a deliberate plan whose purpose is to develop or contribute to generalizable knowledge it is research. Activities which meet this definition constitute research whether or not they are conducted or supported under a program which is considered research for other purposes. For example, some demonstration and service programs may include research activities. —Human Subject
The regulations define human subject as “a living individual about whom an investigator (whether professional or student) conducting research obtains (1) data through intervention or interaction with the individual, or (2) identifiable private information.” (1) If an activity involves obtaining information about a living person by manipulating that person or that person’s environment, as might occur when a new instructional technique is tested, or by communicating or interacting with the individual, as occurs with surveys and interviews, the definition of human subject is met. (2) If an activity involves obtaining private information about a living person in such a way that the information can be linked to that individual (the identity of the subject is or may be readily determined by the investigator or associated with the information), the definition of human subject is met. [Private information includes information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place, and information which has been provided for specific purposes by an individual and which the individual can reasonably expect will not be made public (for example, a school health record).] B. Exemptions. Research activities in which the only involvement of human subjects will be in one or more of the following six categories of exemptions are not covered by the regulations: (1) Research conducted in established or commonly accepted educational settings, involving normal educational practices, such as (a) research on regular and special education instructional strategies, or (b) research on the effectiveness of or the comparison among instructional techniques, curricula, or classroom management methods. (2) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior, unless: (a) information obtained is recorded in such a manner that human subjects can be identified, directly or through identifiers linked to the subjects; and (b) any disclosure of the human subjects’ responses outside the research could reasonably place
the subjects at risk of criminal or civil liability or be damaging to the subjects’ financial standing, employability, or reputation. If the subjects are children, exemption 2 applies only to research involving educational tests and observations of public behavior when the investigator(s) do not participate in the activities being observed. Exemption 2 does not apply if children are surveyed or interviewed or if the research involves observation of public behavior and the investigator(s) participate in the activities being observed. [Children are defined as persons who have not attained the legal age for consent to treatments or procedures involved in the research, under the applicable law or jurisdiction in which the research will be conducted.] (3) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior that is not exempt under section (2) above, if the human subjects are elected or appointed public officials or candidates for public office; or federal statute(s) require(s) without exception that the confidentiality of the personally identifiable information will be maintained throughout the research and thereafter. (4) Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in a manner that subjects cannot be identified, directly or through identifiers linked to the subjects. (5) Research and demonstration projects which are conducted by or subject to the approval of department or agency heads, and which are designed to study, evaluate, or otherwise examine: (a) public benefit or service programs; (b) procedures for obtaining benefits or services under those programs; (c) possible changes in or alternatives to those programs or procedures; or (d) possible changes in methods or levels of payment for benefits or services under those programs. (6) Taste and food quality evaluation and consumer acceptance studies, (a) if wholesome foods without additives are consumed or (b) if a food is consumed that contains a food ingredient at or below the level
and for a use found to be safe, or agricultural chemical or environmental contaminant at or below the level found to be safe, by the Food and Drug Administration or approved by the Environmental Protection Agency or the Food Safety and Inspection Service of the U.S. Department of Agriculture. II. Instructions for Exempt and Nonexempt Human Subjects Research Narratives If the applicant marked “Yes” for Item 13 on the ED 424, the applicant must provide a human subjects “exempt research” or “nonexempt research” narrative and insert it immediately following the ED 424 face page. A. Exempt Research Narrative. If you marked “Yes” for item 13 a. and designated exemption numbers(s), provide the “exempt research” narrative. The narrative must contain sufficient information about the involvement of human subjects in the proposed research to allow a determination by ED that the designated exemption(s) are appropriate. The narrative must be succinct.
specimens, records, or data. Indicate whether the material or data will be obtained specifically for research purposes or whether use will be made of existing specimens, records, or data. (3) Recruitment and Informed Consent: Describe plans for the recruitment of subjects and the consent procedures to be followed. Include the circumstances under which consent will be sought and obtained, who will seek it, the nature of the information to be provided to prospective subjects, and the method of documenting consent. State if the Institutional Review Board (IRB) has authorized a modification or waiver of the elements of consent or the requirement for documentation of consent. (4) Potential Risks: Describe potential risks (physical, psychological, social, legal, or other) and assess their likelihood and seriousness. Where appropriate, describe alternative treatments and procedures that might be advantageous to the subjects. (5) Protection Against Risk: Describe the procedures for protecting against or minimizing potential risks, including risks to confidentiality, and assess their likely effectiveness. Where appropriate, discuss provisions for ensuring necessary medical or professional intervention in the event of adverse effects to the subjects. Also, where appropriate, describe the provisions for monitoring the data collected to ensure the safety of the subjects. (6) Importance of the Knowledge to be Gained: Discuss the importance of the knowledge gained or to be gained as a result of the proposed research. Discuss why the risks to subjects are reasonable in relation to the anticipated benefits to subjects and in relation to the importance of the knowledge that may reasonably be expected to result. (7) Collaborating Site(s): If research involving human subjects will take place at collaborating site(s) or other performance site(s), name the sites and briefly describe their involvement or role in the research.
Copies of the Department of Education’s Regulations for the Protection of Human Subjects, 34 CFR Part 97 and other pertinent materials on the protection of human subjects in research are available from the Grants Policy and Oversight Staff, Office of the Chief Financial Officer, U.S. Department of Education, Washington, D.C.
If you marked “No” for item 13 a. you must provide the “nonexempt research” narrative. The narrative must address the following seven points. Although no specific page limitation applies to this section of the application, be succinct. (1) Human Subjects Involvement and Characteristics: Provide a detailed description of the proposed involvement of human subjects. Describe the characteristics of the subject population, including their anticipated number, age range, and health status. Identify the criteria for inclusion or exclusion of any subpopulation. Explain the rationale for the involvement of special classes of subjects, such as children, children with disabilities, adults with disabilities, persons with mental disabilities, pregnant women, prisoners, institutionalized individuals, or others who are likely to be vulnerable (2) Sources of Materials: Identify the sources of research material obtained from individually identifiable living human subjects in the form of
20202-4250, telephone: (202) 245-6120, and on the U.S. Department of Education’s Protection of Human Subjects in Research Web Site at http://www.ed.gov/about/offices/list/ocfo/humansub.html
General Instructions This form is used to apply to individual U.S. Department of Education (ED) discretionary grant programs. Unless directed otherwise, provide the same budget information for each year of the multi-year funding request. Pay attention to applicable program specific instructions, if attached. Please consult with your Business Office prior to submitting this form. Section A - Budget Summary U.S. Department of Education Funds All applicants must complete Section A and provide a breakdown by the applicable budget categories shown in lines 1-11. Lines 1-11, columns (a)-(e): For each project year for which funding is requested, show the total amount requested for each applicable budget category. Lines 1-11, column (f): Show the multi-year total for each budget category. If funding is requested for only one project year, leave this column blank. Line 12, columns (a)-(e): Show the total budget request for each project year for which funding is requested. Line 12, column (f): Show the total amount requested for all project years. If funding is requested for only one year, leave this space blank. Indirect Cost Information: If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business Office. (1): Indicate whether or not your organization has an Indirect Cost Rate Agreement that was approved by the Federal government. (2): If you checked “yes” in (1), indicate in (2) the beginning and ending dates covered by the Indirect Cost Rate Agreement. In addition, indicate whether ED or another Federal agency (Other) issued the approved agreement. If you check “Other,” specify the name of the Federal agency that issued the approved agreement. (3): If you are applying for a grant under a Restricted Rate Program (34 CFR 75.563 or 76.563), indicate whether you are using a restricted indirect cost rate that is included on your approved Indirect Cost Rate Agreement or whether you are using a restricted indirect cost rate that complies with 34 CFR 76.564(c)(2). Note: State or Local government agencies may not use the provision for a restricted indirect cost rate specified in 34 CFR 76.564(c)(2). Check only one response. Leave blank, if this item is not applicable. Section B - Budget Summary Non-Federal Funds If you are required to provide or volunteer to provide matching funds or other non-Federal resources to the project, these should be shown for each applicable budget category on lines 1-11 of Section B. Lines 1-11, columns (a)-(e): For each project year, for which matching funds or other contributions are provided, show the total contribution for each applicable budget category. Lines 1-11, column (f): Show the multi-year total for each budget category. If non-Federal contributions are provided for only one year, leave this column blank. Line 12, columns (a)-(e): Show the total matching or other contribution for each project year. Line 12, column (f): Show the total amount to be contributed for all years of the multi-year project. If nonFederal contributions are provided for only one year, leave this space blank. Section C - Budget Narrative [Attach separate sheet(s)] Pay attention to applicable program specific instructions, if attached. 1. Provide an itemized budget breakdown, and justification by project year, for each budget category listed in Sections A and B. For grant projects that will be divided into two or more separately budgeted major activities or sub-projects, show for each budget category of a project year the breakdown of the specific expenses attributable to each sub-project or activity. If applicable to this program, provide the rate and base on which fringe benefits are calculated. If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business Office. Specify the estimated amount of the base to which the indirect cost rate is applied and the total indirect expense. Depending on 4. the grant program to which you are applying and/or your approved Indirect Cost Rate Agreement, some direct cost budget categories in your grant application budget may not be included in the base and multiplied by your indirect cost rate. For example, you must multiply the indirect cost rates of “Training grants" (34 CFR 75.562) and grants under programs with “Supplement not Supplant” requirements ("Restricted Rate" programs) by a “modified total direct cost” (MTDC) base (34 CFR 75.563 or 76.563). Please indicate which costs are included and which costs are excluded from the base to which the indirect cost rate is applied. When calculating indirect costs (line 10) for "Training grants" or grants under "Restricted Rate" programs, you must refer to the information and examples on ED’s website at: http://www.ed.gov/fund/grant/apply/appforms/appfor ms.html . You may also contact (202) 377-3838 for additional information regarding calculating indirect cost rates or general indirect cost rate information. Provide other explanations or comments you deem necessary.
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 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, loam or cooperative agreement, the undersigned shall complete and submit Standard Form – LLL, “Disclosure of Lobbying Activities,” in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her knowledge and belief, that: If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee or 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 of Lobbying Activities,” 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. Applicant’s Organization
If submitting hard copy, please place the completed survey in an envelope labeled “Applicant Survey.” Seal the envelope and include it with your application package. If submitting electronically, please include the PR Award Number assigned to your e-application in the box above entitled “Do not enter information below unless instructed to do so.” Place and seal the completed 1. Does the applicant have 501(c)(3) status? Yes No Yes 2. How many full-time equivalent employees does the applicant have? (Check only one box). 3 or Fewer 4-5 6-14 15-50 51-100 over 100 6. Is the applicant an intermediary that will manage the grant on behalf of other organizations? Yes No No 4. Is the applicant a faith-based/religious organization?
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