Standard Form
Standard Form.doc
Application for Asian American and Native American Pacific Islander-Serving Institutions Program and Native American-Serving Non-Tribal Institution Program (1890-0001).
Standard Form
OMB: 1840-0798
IMPORTANT – PLEASE READ FIRST
U.S. Department of Education
GRANTS.GOV SUBMISSION PROCEDURES AND TIPS FOR APPLICANTS
To facilitate your use of Grants.gov, this document includes important submission procedures you need to be aware of to ensure your application is received in a timely manner and accepted by the Department of Education.
REGISTER EARLY – Grants.gov registration may take five or more business days to complete. You may begin working on your application while completing the registration process, but you cannot submit an application until all of the Registration steps are complete. For detailed information on the Registration Steps, please go to: http://www.grants.gov/applicants/get_registered.jsp. [Note: Your organization will need to update its Central Contractor Registry (CCR) registration annually.]
SUBMIT EARLY – We strongly recommend that you do not wait until the last day to submit your application. Grants.gov will put a date/time stamp on your application and then process it after it is fully uploaded. The time it takes to upload an application will vary depending on a number of factors including the size of the application and the speed of your Internet connection, and the time it takes Grants.gov to process the application will vary as well. If Grants.gov rejects your application (see step three below), you will need to resubmit successfully before 4:30 pm on the deadline date.
Note: To submit successfully, you must provide the DUNS number on your application that was used when your organization registered with the CCR.
VERIFY SUBMISSION IS OK – You will want to verify that Grants.gov and the Department of Education receive your Grants.gov submission timely and that it was validated successfully. To see the date/time your application was received, login to Grants.gov and click on the Track My Application link. For a successful submission, the date/time received should be earlier than 4:30 p.m. on the deadline date, AND the application status should be: Validated, Received by Agency, or Agency Tracking Number Assigned.
If the date/time received is later than 4:30 p.m. Washington, D.C. time, on the closing date, your application is late. If your application has a status of “Received” it is still awaiting validation by Grants.gov. Once validation is complete, the status will either change to “Validated” or “Rejected with Errors.” If the status is “Rejected with Errors,” your application has not been received successfully. Some of the reasons Grants.gov may reject an application can be found on the Grants.gov site: http://www.grants.gov/help/submit_application_faqs.jsp#10. For more detailed information on why an application may be rejected, you can review Application Error Tips http://www.grants.gov/section910/ApplicationErrorTips.pdf. If you discover your application is late or has been rejected, please see the instructions below. Note: You will receive a series of confirmations both online and via e-mail about the status of your application. Please do not rely solely on e-mail to confirm whether your application has been received timely and validated successfully.
Submission Problems – What should you do?
If you have problems submitting to Grants.gov before the closing date, please contact Grants.gov Customer Support at 1-800-518-4726 or use the customer support available on the Web site: http://www.grants.gov/applicants/applicant_help.jsp.
If electronic submission is optional and you have problems that you are unable to resolve before the deadline date and time for electronic applications, please follow the transmittal instructions for hard copy applications in the Federal Register notice and get a hard copy application postmarked by midnight on the deadline date.
If electronic submission is required, you must submit an electronic application before 4:30 p.m., unless you follow the procedures in the Federal Register notice and qualify for one of the exceptions to the electronic submission requirement and submit, no later than two weeks before the application deadline date, a written statement to the Department that you qualify for one of these exceptions. (See the Federal Register notice for detailed instructions.)
Helpful Hints When Working with Grants.gov
Please note, once you download an application from Grants.gov, you will be working offline and saving data on your computer. Please be sure to note where you are saving the Grants.gov file on your computer. You will need to logon to Grants.gov to upload and submit the application. You must provide on your application the DUNS number that was used when your organization registered with the CCR.
Please go to http://www.grants.gov/applicants/applicant_help.jsp for help with Grants.gov. For additional tips related to submitting grant applications, please refer to the Grants.gov Submit Application FAQs found on the Grants.gov http://www.grants.gov/help/submit_application_faqs.jsp.
Dial-Up Internet Connections
When using a dial up connection to upload and submit your application, it can take significantly longer than when you are connected to the Internet with a high-speed connection, e.g. cable modem/DSL/T1. While times will vary depending upon the size of your application, it can take a few minutes to a few hours to complete your grant submission using a dial up connection. If you do not have access to a high-speed connection and electronic submission is required, you may want to consider following the instructions in the Federal Register notice to obtain an exception to the electronic submission requirement no later than two weeks before the application deadline date. (See the Federal Register notice for detailed instructions.)
MAC Users
If you do not have a Windows operating System, you will need to use the Citrix solution discussed on Grants.gov or a Windows Emulation program to submit
an application using Grants.gov. For additional information, review the FAQs for non-windows users http://www.grants.gov/resources/download_software.jsp#non_window. Also, to view white paper for Macintosh users published by Pure Edge go to the following link: http://www.grants.gov/section678/PureEdgeSupportforMacintosh.pdf, and/or contact Grants.gov Customer Support (http://www.grants.gov/contactus/contactus.jsp) for more information. If electronic submission is required and you are concerned about your ability to submit electronically as a non-windows user, please follow instructions in the Federal Register notice to obtain an exception to the electronic submission requirement no later than two weeks before the application deadline date. (See the Federal Register notice for detailed instructions.)
ATTENTION – Microsoft Vista and Word Users
Please note that Grants.gov does not currently support the new Microsoft Vista Operating system. The PureEdge software used by Grants.gov for forms is not compatible with Vista.
In addition, the new version of Microsoft Word saves documents with the extension .DOCX. The Grants.gov system does not process Microsoft Word documents with the extension .DOCX. When submitting Microsoft Word attachments to Grants.gov, please use the version of Microsoft Word that ends in .DOC. If you have any questions regarding this matter please email the Grants.gov Contact Center at [email protected] or call 1-800-518-4726.
GRANTS.GOV REGISTRATION INSTRUCTIONS FOR ORGANIZATIONS
The Grants.gov registration process involves three basic steps:
Register your organization
Obtain a D-U-N-S Number (see below for instructions)
Register with the Central Contractor Registry (see below for instructions)
Register yourself as an Authorized Organization Representative (AOR)
Obtain a username and password from the Grants.gov credential provider (https://apply.grants.gov/OrcRegister)
Register with Grants.gov (https://apply.grants.gov/GrantsgovRegister)
Get authorized as an AOR by your organization
Receive approval from your organization’s E-Business POC (see CCR instructions below for details)
If you are both the E-Business POC and an AOR, you should authorize your own AOR request
For more information, go to: http://www.grants.gov/applicants/get_registered.jsp.
Note: If you are a grant applicant who is submitting a grant application on your own behalf and not on behalf of a company, institution, state, local or tribal government, or other type of organization, refer to http://www.grants.gov/assets/IndividualRegCheck.pdf. If you apply as an individual to a grant application package designated for organizations, your application will be rejected.
D-U-N-S NUMBER INSTRUCTIONS
To successfully submit an application using Grants.gov, you must provide your organization’s D-U-N-S Number. A D-U-N-S Number is a unique nine-digit number issued by Dun and Bradstreet (D&B), a global information services provider, that identifies your organization and is used by the Federal government to track how Federal money is distributed. Most large organizations, libraries, colleges, and research universities already have D-U-N-S numbers. Ask your grant administrator or chief financial officer to provide your organization’s D-U-N-S Number.
If your organization does not have a D-U-N-S Number, you can obtain one at no charge by calling 1-866-705-5711 or by completing a D-U-N-S Number Request Form (http://www.dnb.com/US/duns_update/index.html). You will need to provide the following information:
Legal name
Tradestyle, doing business as (DBA), or other name by which your organization is commonly recognized
Physical address, city, state and zip code
Mailing address (if separate)
Telephone number
Contact name
SIC code (Line of Business)
Number of employees at your location
Headquarters name and address (if there is a reporting relationship to a parent corporate entity)
Is this a home-based business?
Obtaining a DUNS Number places your organization on D&B’s marketing list, which is sold to other companies. You can request not to be added to this list during your application.
Live help from D&B is available Monday-Friday, 8 a.m. – 5 p.m. (EST) at 1-888-814-1435.
CENTRAL CONTRACTOR REGISTRATION (CCR) INSTRUCTIONS
The Central Contractor Registration (CCR) is a web-enabled government-wide application that collects, validates, stores, and disseminates business information about the Federal government's trading partners in support of the
contract award, grants, and electronic payment processes. Check to see if your organization is already registered at the CCR website (http://www.bpn.gov/ccrinq/scripts/search.asp).
If your organization is already registered, take note of who is listed as your E-Business Point of Contact (E-Business POC). This person will be responsible for authorizing who within your organization is able to submit applications using Grants.gov.
If your organization is not already registered, you can register using the CCR website (https://www.bpn.gov/ccr/scripts/indexnew.asp) or by phone (1-888-227-2423). When your organization registers with CCR, you will need to designate an E-Business Point of Contact (POC). This designee authorizes individuals to submit grant applications on behalf of the organization. A special Marketing Partner ID Number (MPIN) is established as a password to verify the E-Business POC.
The E-Business POC will be notified by e-mail when individuals from their organization register with Grants.gov. This registration is a request to be designated as an Authorized Organization Representative (AOR). To assign AOR rights, E-Business POCs need to log into Grants.gov (http://www.grants.gov/applicants/e_biz.jsp) using the organization’s D-U-N-S Number and MPIN. Grants.gov will send the AOR a confirmation e-mail when this process has been completed.
Please note that your CCR registration must be renewed once a year. You can check your registration status using the CCR search page (http://www.bpn.gov/ccrinq/scripts/search.asp).
If you have further questions about creating, updating or renewing your CCR registration, please visit the CCR Frequently Asked Questions page (http://www.ccr.gov/FAQ.asp) or contact the CCR Help Desk at 1-888-227-2423.
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.
This program requires the electronic submission of applications; specific requirements and waiver instructions can be found in the Federal Register notice.
According to the instructions found in the Federal Register notice, those requesting and qualifying for an exception to the electronic submission requirement may submit an application by mail, commercial carrier or by hand delivery.
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, D.C. time) on or before the deadline date.
If you submit your application through the Internet via the Grants.gov Web site, you will receive an automatic acknowledgement 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 or visit http://www.grants.gov.
Applications Delivered by Mail
You must mail the original and two copies of your application on or before the application deadline date to:
U.S. Department of Education
Application Control Center
Attention: CFDA Number 84.
400 Maryland Avenue, S.W.
Washington, D.C. 20202-4260
You must show one of the following as proof of mailing:
A legibly dated U.S. Postal Service Postmark
A legible mail receipt with the date of mailing stamped by the U.S. Postal Service
A dated shipping label, invoice, or receipt from a commercial carrier
Any other proof of mailing acceptable to the U.S. Secretary of Education
If you mail an application through the U.S. Postal Service, we do not accept either of the following as proof of mailing:
A private metered postmark, or
A mail receipt that is not dated by the U.S. Postal Service
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.
Special Note: Due to potential disruption 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 Postal
Service; U.S. Postal Service Express Mail; or a courier service 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 Delivered by Mail”, then follow the instructions for “Applications Delivered by Hand”.
Applications Delivered by Commercial Carrier
If you use an alternative delivery method, please obtain the appropriate proof of mailing under “Applications Sent by Mail”, then follow the instructions under the appropriate delivery method.
You must mail the original and two copies of your application on or before the application deadline date to:
U.S. Department of Education
Application Control Center – Stop 4260
Attention: CFDA Number 84.
7100 Old Landover Road
Landover, MD 20785-1506
Applications Delivered by Hand
You or your courier must hand deliver the original and two copies of the application by 4:30 p.m. (Washington, D.C. time) on or before the deadline date to the following address:
U.S. Department of Education
Application Control Center
Attention: CFDA Number 84.
550 12th Street, SW
Potomac Center Plaza – Room 7067
Washington, D.C. 20202-4260
Application Control Center Hours of Operation
The Application Control Center accepts application deliveries daily between 8:00 a.m. and 4:30 p.m. (Washington, D.C. time) except Saturdays, Sundays, and Federal holidays.
Grant Application Receipt from the Application Control Center
If you send your application by mail or if you or your courier delivers it by hand, the Application Control Center will mail a Grant Application Receipt Acknowledgement to you.
If you do not receive the notification of application receipt within 15 days from the mailing of the application, you should call the U.S. Department of Education Application Control Center at (202) 245-6288.
Late Applications
If your application is late, we will notify you that we will not consider the application.
INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This is a standard form (including the continuation sheet) required for use as a cover sheet for submission of preapplications and applications and related information under discretionary programs. Some of the items are required and some are optional at the discretion of the applicant or the Federal agency (agency). Required items are identified with an asterisk on the form and are specified in the instructions below. In addition to the instructions provided below, applicants must consult agency instructions to determine specific requirements.
Item |
Entry: |
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Entry: |
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1. |
Type of Submission: (Required): Select one type of submission in accordance with agency instructions.
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10. |
Name Of Federal Agency: (Required) Enter the name of the Federal agency from which assistance is being requested with this application. |
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11. |
Catalog Of Federal Domestic Assistance Number/Title: Enter the Catalog of Federal Domestic Assistance number and title of the program under which assistance is requested, as found in the program announcement, if applicable.
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2. |
Type of Application: (Required) Select one type of application in accordance with agency instructions.
A. Increase Award B. Decrease Award C. Increase Duration D. Decrease Duration E. Other (specify) |
12. |
Funding Opportunity Number/Title: (Required) Enter the Funding Opportunity Number and title of the opportunity under which assistance is requested, as found in the program announcement. |
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13. |
Competition Identification Number/Title: Enter the Competition Identification Number and title of the competition under which assistance is requested, if applicable. |
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14. |
Areas Affected By Project: List the areas or entities using the categories (e.g., cities, counties, states, etc.) specified in agency instructions. Use the continuation sheet to enter additional areas, if needed. |
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3. |
Date Received: Leave this field blank. This date will be assigned by the Federal agency.
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15. |
Descriptive Title of Applicant’s Project: (Required) Enter a brief descriptive title of the project. If appropriate, attach a map showing project location (e.g., construction or real property projects). For preapplications, attach a summary description of the project. |
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4. |
Applicant Identifier: Enter the entity identifier assigned by the Federal agency, if any, or applicant’s control number, if applicable. |
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5a |
Federal Entity Identifier: Enter the number assigned to your organization by the Federal Agency, if any. |
16. |
Congressional Districts Of: (Required) 16a. Enter the applicant’s Congressional District, and 16b. Enter all District(s) affected by the program or project. Enter in the format: 2 characters State Abbreviation – 3 characters District Number, e.g., CA-005 for California 5thth district, CA-012 for California 12th district, NC-103 for North Carolina’s 103rd district.
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5b. |
Federal Award Identifier: For new applications leave blank. For a continuation or revision to an existing award, enter the previously assigned Federal award identifier number. If a changed/corrected application, enter the Federal Identifier in accordance with agency instructions. |
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6. |
Date Received by State: Leave this field blank. This date will be assigned by the State, if applicable. |
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7. |
State Application Identifier: Leave this field blank. This identifier will be assigned by the State, if applicable. |
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8. |
Applicant Information: Enter the following in accordance with agency instructions:
a. Legal Name: (Required): Enter the legal name of applicant that will undertake the assistance activity. This is the name that the organization has registered with the Central Contractor Registry. Information on registering with CCR may be obtained by visiting the Grants.gov website. |
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17. |
Proposed Project Start and End Dates: (Required) Enter the proposed start date and end date of the project. |
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b. Employer/Taxpayer Number (EIN/TIN): (Required): Enter the Employer or Taxpayer Identification Number (EIN or TIN) as assigned by the Internal Revenue Service. If your organization is not in the US, enter 44-4444444. |
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18. |
Estimated Funding: (Required) Enter the 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. |
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c. Organizational DUNS: (Required) Enter the organization’s DUNS or DUNS+4 number received from Dun and Bradstreet. Information on obtaining a DUNS number may be obtained by visiting the Grants.gov website. |
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d. Address: Enter the complete address as follows: Street address (Line 1 required), City (Required), County, State (Required, if country is US), Province, Country (Required), Zip/Postal Code (Required, if country is US). |
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19. |
Is Application Subject to Review by State Under Executive Order 12372 Process? Applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State intergovernmental review process. Select the appropriate box. If “a.” is selected, enter the date the application was submitted to the State |
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e. Organizational Unit: Enter the name of the primary organizational unit (and department or division, if applicable) that will undertake the assistance activity, if applicable. |
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f. Name and contact information of person to be contacted on matters involving this application: Enter the name (First and last name required), organizational affiliation (if affiliated with an organization other than the applicant organization), telephone number (Required), fax number, and email address (Required) of the person to contact on matters related to this application. |
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20. |
Is the Applicant Delinquent on any Federal Debt? (Required) Select the appropriate box. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of debt include delinquent audit disallowances, loans and taxes.
If yes, include an explanation on the continuation sheet. |
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9. |
Type of Applicant: (Required) Select up to three applicant type(s) in accordance with agency instructions. |
21. |
Authorized Representative: (Required) To be signed and dated by the authorized representative of the applicant organization. Enter the name (First and last name required) title (Required), telephone number (Required), fax number, and email address (Required) of the person authorized to sign for the applicant. A copy of the governing body’s authorization for you to sign this application as the 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.)
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INSTRUCTIONS FOR DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424
1. Project Director. Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on matters involving this application.
2. 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 Department of Education Supplemental Information for SF 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.
3. Human Subjects Research. (See I. A. “Definitions” in attached page entitled “Definitions for Department of Education Supplemental Information For SF 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 3 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 Department of Education Supplemental Information For SF 424.”)
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 Department of Education Supplemental Information For SF 424.”
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 Department of Education Supplemental Information For SF 424
Human Subjects Assurance Number. If the applicant has an approved Federal Wide (FWA) on file 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 SF-424, 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.
Paperwork Burden Statement. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1890-0017. The time required to complete this information collection is estimated to average between 15 and 45 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4700. If you have comments or concerns regarding the status of your individual submission of this form write directly to: Joyce I. Mays, Application Control Center, U.S. Department of Education, Potomac Center Plaza, 550 12th Street, S.W. Room 7076, Washington, D.C. 20202-4260.
DEFINITIONS FOR DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424
(Attachment to Instructions for Supplemental Information for SF 424)
Definitions:
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.
In the case of a group application submitted in accordance with 34 CFR 75.127-75.129, a group includes only parties that meet the requirements listed above.
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 that 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 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 3 of Department of Education Supplemental Information for SF 424, the applicant must provide a human subjects “exempt research” or “nonexempt research” narrative. Insert the narrative(s) in the space provided. If you have multiple projects and need to provide more than one narrative, be sure to label each set of responses as to the project they address.
A. Exempt Research Narrative.
If you marked “Yes” for item 3 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.
B. Nonexempt Research Narrative.
If you marked “No” for item 3 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 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, DC 20202-4250, telephone: (202) 245-6120, and on the U.S. Department of Education’s Protection of Human Subjects in Research Web Site: http://www.ed.gov/about/offices/list/OCFO/humansub.html
NOTE: The State Applicant Identifier on the SF 424 is for State Use only. Please complete it on the OMB Standard 424 in the upper right corner of the form (if applicable).
INSTRUCTIONS FOR ED 524
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 non-Federal 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.
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 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/appforms.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.
Paperwork Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1890-0004. The time required to complete this information collection is estimated to vary from 13 to 22 hours per response, with an average of 17.5 hours per response, including the time to review instructions, search existing data sources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to (insert program office), U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202.
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.
6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., “RFP-DE-90-001.”
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503
OMB Number: 4040-0004
Expiration Date: 01/31/2009
Version 02
Application for Federal Assistance SF-424 |
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*19. Is Application Subject to Review By State Under Executive Order 12372 Process? a. This application was made available to the State under the Executive Order 12372 Process for review on b. Program is subject to E.O. 12372 but has not been selected by the State for review. c. Program is not covered by E. O. 12372 |
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*20. Is the Applicant Delinquent On Any Federal Debt? (If “Yes”, provide explanation.) Yes No |
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21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U. S. Code, Title 218, Section 1001) ** I AGREE ** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions |
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Authorized for Local Reproduction Standard Form 424 (Revised 10/2005)
Prescribed by OMB Circular A-102
OMB Number: 4040-0004 Expiration Date: 01/31/2009 |
Application for Federal Assistance SF-424 Version 02 |
*Applicant Federal Debt Delinquency Explanation The following should contain an explanation if the Applicant organization is delinquent of any Federal Debt.
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SUPPLEMENTAL INFORMATION REQUIRED FOR DEPARTMENT OF EDUCATION
1. Project Director:
Prefix: *First Name: Middle Name: *LastName: Suffix:
Address:
* Street1:
Street2:
* City:
County:
* State * Zip Code: * Country:
* Phone Number (give area code) Fax Number (give area code)
Email Address:
2. Applicant Experience:
N
ovice
Applicant
Yes No Not applicable to this program
3. Human Subjects Research:
Are any research activities involving human subjects planned at any time during the proposed project Period?
Yes No
A
re
ALL the research activities proposed designated to be exempt from the
regulations?
Yes Yes Provide Exemption(s) #:
No No Provide Assurance #, if available:
P
lease
attach an explanation Narrative:
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 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. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the basis of
age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 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. 276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), regarding labor standards for federally assisted construction 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. 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. 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. 1721 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. 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 Amendments of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non-Profit Organizations.
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
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APPLICANT ORGANIZATION
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Standard Form 424B (Rev. 7-97) Back
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U.S. DEPARTMENT OF EDUCATION BUDGET INFORMATIONNON-CONSTRUCTION PROGRAMS |
OMB Control Number: 1890-0004 Expiration Date: 10-31-2007 |
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Name of Institution/Organization
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Applicants requesting funding for only one year should complete the column under "Project Year 1." Applicants requesting funding for multi-year grants should complete all applicable columns. Please read all instructions before completing form. |
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SECTION A - BUDGET SUMMARY U.S. DEPARTMENT OF EDUCATION FUNDS |
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Budget Categories |
Project Year 1 (a) |
Project Year 2 (b) |
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Total (f) |
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*Indirect Cost Information (To Be Completed by Your Business Office): If you are requesting reimbursement for indirect costs on line 10, please answer the following questions:
Period Covered by the Indirect Cost Rate Agreement: From: ___/___/______ To: ___/___/______ (mm/dd/yyyy) Approving Federal agency: ____ ED ____ Other (please specify): __________________________
___ Is included in your approved Indirect Cost Rate Agreement? or ___ Complies with 34 CFR 6.564(c)(2)?
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SECTION B - BUDGET SUMMARY NON-FEDERAL FUNDS |
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SECTION C – BUDGET NARRATIVE (see instructions) |
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ED 524
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 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
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Printed Name of Authorized Representative Printed Title of Authorized Representative
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Signature Date
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ED 80-0013 08/05
OMB No. 1890-0014, Exp. 02/28/09
Survey on Ensuring Equal Opportunity for Applicants
Purpose:
The Federal
government is committed to ensuring that all qualified applicants,
small or large, non-religious or faith-based, have an equal
opportunity to compete for Federal funding. In order for us to
better understand the population of applicants for Federal funds, we
are asking nonprofit private organizations (not including private
universities) to fill out this survey.
Upon
receipt, the survey will be separated from the application.
Information provided on the survey will not be considered in any way
in making funding decisions and will not be included in the Federal
grants database. While your help in this data collection process is
greatly appreciated, completion of this survey is voluntary.
Instructions
for Submitting the Survey:
If you are
applying using a hard copy application, please place the completed
survey in an envelope labeled “Applicant Survey.” Seal
the envelope and include it along with your application package.
If you are applying electronically, please submit this survey along
with your application.
Applicant’s (Organization) Name: ____________________________________________________________
Applicant’s DUNS Number: _________________________________________________________________
Federal Program: ________________________________________________CFDA Number: ___________
1. Has the applicant ever received a grant or contract from the Federal government?
Yes No
2. Is the applicant a faith-based organization?
Yes No
3. Is the applicant a secular organization?
Yes No
4. Does the applicant have 501(c)(3) status?
Yes No
5. Is the applicant a local
affiliate of a national
organization?
Yes No
6. How many full-time equivalent employees does the applicant have? (Check only one box).
3
or Fewer 15-50
4
-5 51-100
6-14 over 100
7. What is the size of the applicant’s annual budget? (Check only one box.)
Less
Than $150,000
$150,000
- $299,999
$300,000
- $499,999
$500,000
- $999,999
$1,000,000
- $4,999,999
$5,000,000
or more
Approved by OMB
0348-0046
Disclosure of Lobbying Activities
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure)
a. contract ____ b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance |
a. bid/offer/application _____ b. initial award c. post-award |
a. initial filing _____ b. material change
For material change only: Year _______ quarter _______ Date of last report___________
|
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____ Prime _____ Subawardee Tier______, if Known:
Congressional District, if known: |
Congressional District, if known: |
||
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7. Federal Program Name/Description:
CFDA Number, if applicable: __________________ |
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9. Award Amount, if known:
$ |
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10. a. Name and Address of Lobbying Registrant (if individual, last name, first name, MI):
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b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI):
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11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. |
Signature: __________________________________
Print Name: _____
Title: _____
Telephone No.: ____________ Date: _______ |
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Federal Use Only |
Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) |
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| File Type | application/msword |
| File Title | INSTRUCTIONS FOR THE SF-424 |
| Author | Bernadette.Miles |
| Last Modified By | yifwanda.ndjungu |
| File Modified | 2008-02-28 |
| File Created | 2008-02-05 |
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