Form 1 Martin Luther King, Jr. Day of Service Grant Application

Martin Luther King, Jr. Day of Service Grants

Application Instructions

OMB Control #: 3045-0110

Expiration Date: XX XX, XXXX

TABLE OF CONTENTS

1. Introduction ……………………………………………….…………………..	4
2. Submission and Compliance Requirements………………………………….	4
3. Helpful Hints……………………………………………………………………	5
4. Application Instructions…………………….. …………………………..……	6
5. APPENDIX A – SF424 Facesheet and Instructions…………………………	13
6. APPENDIX B – Assurances and Certifications……………………………..	17
Assurances……………………………………………………………………	18
Certifications…………………………………………………………………	19
7. APPENDIX C – Performance Measurement Worksheet …………………..	22
8. APPENDIX D – SF424A Budget Instructions and Worksheet……………..	23
9. APPENDIX E – Survey on Ensuring Equal Opportunity for Applicants...	28

IMPORTANT NOTICE

The Corporation for National and Community Service has changed its application instructions to conform to the on-line grant application system, eGrants. The Corporation will also use the grants.gov site, which is the government wide portal.

Public Burden Statement: The Paperwork Reduction Act of 1995 requires the Corporation to inform all potential persons who are to respond to this collection of information that such persons are not required to respond unless it displays a currently valid OMB control number. (See 5 C.F.R. 1320.5(b)(2)(i)). Time Burden: The time required to complete this collection of information is estimated to average 10 hours per applicant, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. Use of Information: The information collected constitutes an application to the Corporation for grant funding. The Corporation evaluates the application and makes funding decisions through the Corporation’s grant review and selection process. Effects of Non-Disclosure: Providing this information is voluntary; however, failure to provide the information would not allow the Corporation to assess the applicant’s request for funding. Therefore it would not be possible to consider granting funds to the applicant. Public Comments: Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, Georgia State Office, Attn: Rochelle Barry, 75 Piedmont Avenue, N.E. Atlanta, GA 30303. Privacy Act: Information provided for this collection may be shared with federal, state, and local agencies for law enforcement purposes.

Introduction

To develop your application, you need to carefully read these Instructions, the MLK Day of Service Grants Notice of Funding Availability, and any additional guidance given by the Corporation for National and Community Service regarding the MLK Day of Service Grants. These instructions, in tandem with our instructions on using eGrants and the supplemental information we provide, will help you complete your application. You may access all of this information at our website, http://www.nationalservice.org/funding_initiatives/index.html.

Submission and Compliance Requirements

The Corporation requires that all applicants make every effort to submit your application electronically utilizing the Corporation’s web-based application system, eGrants. Please go to http://www.nationalservice.gov/egrants/ and create an eGrants account to begin the process of submitting your application online. Instructions on how to create an account are available at this website.

The Corporation strongly encourages you to create your eGrants account and begin your application at least three weeks prior to the final submission deadline and begin pasting your application into eGrants no later than ten days before the deadline. This will allow you time to address any technical issues prior to the deadline. Technical issues are more likely to be considered as a factor in allowing a late submission if you begin entering your application within this time frame

Please refer to the Notice of Funding Availability for the application deadline. In the event you are prevented from completing and submitting your application by the deadline because the eGrants system is unavailable or you are having technical eGrants submission issues, you must contact the eGrants Helpdesk at 888-677-7849 or email at [email protected] , prior to the 5:00 p.m. ES/DT deadline to explain your technical issue and receive an eGrants ticket number.

You must then submit the following items in hard copy to the Corporation:

• A brief paragraph including your eGrants ticket number and your explanation of the technical issues that prevented you from submitting in eGrants by the deadline;

• A paper application; and

• A diskette or CD Rom with an exact duplicate of your application.

Submit these items via overnight carrier (non-US Postal Service because of security–related delays in receiving mail from USPS) or by hand delivery to: Corporation for National and Community Service, Box MLK Grants, 1201 New York Avenue, N.W., Washington, DC 20525. These items must be postmarked no later than noon one day after the published deadline and received at the Corporation no later than 5:00 p.m. Eastern Time two days after the published deadline. Applications submitted by fax or email will not be accepted.

The paper application must be typed and double-spaced in Times New Roman, 12-point font size with one-inch margins.  Please adhere to the character limits listed in this Notice and number the pages.  Submit one unbound, single-sided original paper application.  The electronic version on disk or CD must be an exact duplicate of the paper original and will be used to copy and paste your application information into eGrants.  If there are differences between the paper application and the disk or CD, we will use the disk or CD version. 

In the event of prolonged unavailability of the eGrants system on the date of submission, the Corporation reserves the right to extend the eGrants submission deadline. A notice will be placed in eGrants and on http://www.MLKDay.gov with the extended deadline.

We require applicants to:

• Submit applications by the posted deadline.

• Adhere to the character limits listed in the narrative section below¹.

The Corporation reserves the right to review any application that is submitted.

Helpful Hints

• We suggest that you prepare and save your application as a word processing document prior to inputting it into eGrants.

• Use only uppercase letters for all section headings and other information you would like to highlight in your narrative.  Bold face, bullets, underlines, or other types of formatting, charts, diagrams, and tables will not copy into eGrants.   Do not use any of these in your application whether using eGrants or submitting by paper.

• Remember to follow the character limits.  We use character limits rather than page limits because of the structure of eGrants.  Characters include letters, punctuation, and spaces in the document.  Your word processing software can provide a character count. 

• Grant applications must provide a Dun and Bradstreet Data Universal Numbering System (DUNS) number.  The DUNS number is known as the universal identifier and helps the federal government improve statistical reports on federal grants and cooperative agreements.  The DUNS number will not replace the EIN.  DUNS numbers may be obtained at no cost by calling the DUNS number request line at (866) 705-5711.  There is a DUNS number field in the Organization section in eGrants. 

Application Instructions: MLK Day of Service Grants

Submit an application that consists of the following components in the following order.

1. SF424 Facesheet (eGrants “Applicant & Application Information” Sections)

Complete the Applicant and Application information sections². See Appendix A.

2. Narrative (eGrants “Narratives” Section)

Provide a well-designed plan with a clear and compelling justification for awarding the requested funds. The narrative will cover the grant project period for which you are requesting approval.

The Narrative includes:

1. Executive Summary (2,000 characters)

2. Program Design

3. Organizational Capacity

4. Budget/Cost Effectiveness

The maximum length for the Executive Summary is 2,000 characters. The maximum length for the Program Design, Organizational Capacity, and Budget/Cost Effectiveness is 41,000 characters. Although each of these fields has a maximum capacity of 32,000 characters, the total of all five fields combined cannot be more than 41,000 characters.³ This allows you flexibility in the number of characters you place in each field.

1. Executive Summary

Provide a concise overview of the proposed project that summarizes the need, the proposed strategy for addressing the need, anticipated outcomes and accomplishments, how the outcomes will be achieved and measured, and the estimated length of time needed to complete the project.

2. Program Design

1. Background. Describe your organization, its role in the community, and the community need(s) that the organization seeks to address through this Martin Luther King, Jr. Day of Service grant. Your description should address the following:

1. The organization’s mission, history, age, accomplishments, beneficiaries, and network.

2. How you would use the grant to exponentially expand the King Day of Service and engage volunteers beyond the day of service.

3. The community need(s) your project is designed to address by Martin Luther King, Jr. Day of Service grants. Use verifiable data or existing research and reports to support your description of the problem or need. Describe how you would intentionally connect these activities to Dr. King’s teachings.

4. Your outreach efforts and selection process you plan to use for identifying and choosing subgrantees.

2. Proposed Strategy. Describe your approach to addressing the need or problem described in the background section. Applicants must include a plan for mobilizing non-paid volunteers, e.g., seniors, students, disadvantaged youth, and other members of the community of all ages and backgrounds, in the implementation of the program.

Your strategy to secure nonfederal resources to build sustainable service and volunteer programs should address the following:

1. Goals and Objectives. What are your proposed project’s target goals and objectives to make a difference in the community? What are the expected outcomes and how will they be measured? Target goals should include demonstrating an increased capacity for volunteer management in nonprofit organizations resulting in a measurable impact on the community served over the three years of the grant. Include targets around projected growth of the King Day of Service over the three years of the grant.

2. Program Strategy. What is the logical connection between the community need(s) you describe and the approach you are proposing? In describing the strategy, address the following:

   1. Who is the target population or beneficiaries of this proposed project? How will you engage disadvantaged youth in the project?

   2. Why is service an appropriate intervention to address the community need(s)? How do planned activities connect to Dr. King’s teachings?

   3. How will the program track the number of new volunteers and the number of service hours they perform?

3. Community Resources. How will you use existing community resources, such as other service or community organizations and community volunteers, to implement your approach? How will the proposed program bring additional beneficial resources to the community?

4. Program Sustainability. Provide details on how the program will work to sustain

itself and its service activities beyond the grant period.

5. Federal Work Study (For Higher Education Institutions Only). How will you use Federal Work Study to promote the service activities in your proposed strategy?

6. Description of Activities. Please describe in detail the activities of the proposed program and provide a timeline for the activities. The description should include all activities associated with the project, including but not limited to:

1. The recruitment, support, and management of community volunteers;

2. Service activities;

3. The roles of community volunteers in delivering the proposed service activities; and,

4. The anticipated role and activities of community partners, including faith-based and other community organizations.

3. Organizational Capacity

Describe your capacity to implement and manage the proposed program to build sustainable service and volunteer programs. As an intermediary organization, your description should address the following:

1. Ability to Provide Program Oversight. Describe the demonstrated experience and infrastructure your organization has in managing programs similar to the one proposed in this application. Describe your organization’s ability to select and monitor subgrants. Who are the key staff responsible for program oversight? Detail the responsibilities of each key staff member.

2. Ability to Provide Fiscal Oversight. Describe the demonstrated experience and infrastructure your organization has in managing grants. What is your current organizational budget and what percentage of the budget would this grant represent? Who are the key staff responsible for fiscal oversight, and what past experience will they bring to program? Detail the responsibilities of each key staff member.

3. Volunteer Management. What experience does your organization have with recruiting and managing volunteers? What capacity does your organization currently have to recruit and manage volunteers?

4. Training and Technical Assistance. Describe your plans and your capacity to provide or secure needed training and technical assistance for this project to support broad expansion of the King Day of Service.

5. Evaluation and Continuous Improvement. Describe your plans and your capacity (current and anticipated) to implement and use self-assessment, evaluation, and continuous improvement systems to provide data and information on the success of the project.

4. Budget/Cost-Effectiveness

1. Budget and Program Design. Explain how the proposed program budget reflects the program’s goals and design.

2. Match Sources. Detail the amounts and sources for the proposed non-federal match required for the grant. Identify the amounts and sources of any other in-kind contributions to this project. Matching funds can be in-kind or cash. The Corporation will make awards covering a period not to exceed the grant period.

E. Authorization, Assurances, and Certifications (eGrants “Authorize and Submit”Section) See Appendix B

Read the authorization, assurances, and certifications carefully. Complete each section of the Authorize and Submit section.

Note: The Authorized Representative is the official within the applicant organization with the legal authority to give assurances, make commitments, enter into contracts, and execute such documents on behalf of the applicant as may be required by the grant maker. The signature of the Authorized Representative certifies that commitments made on grant proposals will be honored and ensures that the applicant agrees to conform to the grant maker’s regulations, guidelines, and policies. Note that the Authorized Representative is not necessarily the Project Director.

6. Performance Measurements

Martin Luther King, Jr. Day of Service grantees are required to submit performance measures, as appropriate to their program, that relate to the citizen service that will be carried out with the grant. The performance measures are a requirement of the grant. Grantees are accountable for achieving these measures during the period of the grant and for reporting on expected accomplishments.

For more information about performance measures under Corporation grants, including a toolkit to assist in the development and implementation of performance measures, visit the Corporation technical assistance provider’s website at: http://www.projectstar.org.

Use the Performance Measurement Worksheet in Appendix C as a guide.

7. Budget (eGrants “Budget” Section)

See Appendix D. The budget should be sufficient to perform the tasks described in the proposal narrative for the first year of the grant. Do not include unexplained amounts, amounts for miscellaneous or contingency costs, or unallowable expenses such as entertainment costs. Costs may include travel necessary to meet grant and grantee obligations. Round all figures to the nearest dollar. Budgets for subsequent program years will be developed and submitted prior to approval of continuation grants for the second and third years.

We recommend you prepare your project budget off-line before entering it into eGrants. eGrants will create the budget and the budget narrative automatically from the detailed budget information you entered.

Budget Categories are:

1. Project Personnel Expenses

2. Personnel Fringe Benefits

3. Travel

4. Equipment

5. Supplies

6. Contractual and Consultant Services

7. Training

8. Evaluation

9. Other Support Costs

10. Indirect Costs

8. Survey on Ensuring Equal Opportunity for Applicants

The Corporation and other Federal agencies are collaborating with the White House Office of Faith-Based and Community Initiatives (FBCI) to conduct a survey of organizations that have received Federal funding. The purpose of this voluntary information collection is to compile statistics on the types of organizations that apply to the Corporation for funds, such as number of employees, budget size, and self-identification as a faith-based/religious organization or a non-religious community-based organization.

Applicants are asked to complete the Survey on Ensuring Equal Opportunity for Applicants. You can find this Survey at http://www.nationalservice.gov/for_organizations/funding/nofa.asp.

This form is for applicants that are private nonprofit organizations (not including private universities). All information from the attached survey will be confidential and the responses will be aggregated in-house for a summary report. Information provided on your form will not be released and will not be considered in any way in making funding decisions.

If you are submitting a paper application, the survey forms and instructions are found in Appendix E.

9. Reporting Requirements for Applicants Selected for Awards

Applicants who are selected for awards will be subject to the following reporting requirements:

Grantees are required to provide an interim report, listing subgrants, the anticipated number of volunteers, and the estimated number of volunteer hours that will be served on a date to be determined. For the second and third program years, grantees will submit this interim report on a date to be determined. For each year’s Day of Service activities, grantees must ensure all project sites report on the projects funded, the number of volunteers who served on that day, the number of service hours accomplished over the course of the Holiday service projects, and any other notable accomplishments.

Grantees are required to submit annual progress performance reports, annual financial reports, and evaluation reports.

Grantees and their subgrantees are expected to participate in conference calls, trainings, meetings, and conferences.

9. If selected for funding additional documents maybe required (Documents Section)

All additional documents must be submitted to the Corporation by the application deadline. Forms submitted by fax or email will not be accepted. Materials should be mailed to:

Corporation for National and Community Service

Attn: MLK Day of Service Grants

1201 New York Avenue N.W.

Washington, D.C. 20525

Include a hard copy of the completed SF424 Facesheet with the materials to indicate with which application the documents correspond.

This Page Intentionally Left Blank

APPENDIX A: SF424 INSTRUCTIONS and FACESHEET

This form is required for applications submitted for federal assistance.

Item #

1. Filled in for your convenience.

2. Self-explanatory.

3. 3.a. and 3.b. are for State use only. (Leave Blank: Not Applicable for MLK Day of Service Grants)

4. 4.a: Leave blank

4.b: Leave blank.

5. Enter the following information:

1. The complete name of the organization that will be legally responsible for the grant. Not the name of the organizational unit within the legally responsible organization. (For example, indicate “National University” instead of “Liberal Arts Department.”)

2. The name of the primary organizational unit that will undertake the assistance activity, if different from 5.a.

3. Your organization’s DUNS number (received from DUN and Bradstreet).

4. Your organization’s complete address with the 5 digit ZIP code. The four-digit extension is optional.

5. The name and contact information of the project director or other person to contact on matters related to this application.

6. Enter your Employer Identification Number (EIN) as assigned by the Internal Revenue Service.

7. 7.a.: Enter the appropriate letter in the box.

7.b.: Consult the following list of characteristics of applicants and enter (all that apply) the corresponding numbers, each in a separate blank.

1. 2-year college

2. 4-year college

3. Area Agency on Aging

4. Chamber of Commerce/Business Association

5. Community Action Agency/ Community Action Program

6. Community College

7. Community-Based Organization

8. Faith-based organization

9. Governor’s Office

10. Grant-making Entity Operating in Two or More States

11. Health Department

12. Hispanic Serving College or University

13. Historically Black College or University (HBCU)

14. Law Enforcement Agency

15. Local Affiliate of National Organization

16. Local Education Agency

17. Local Government Municipal

18. National Non-profit (Multi-state)

19. Other Native American Organization

20. Other State Government

21. School (K-12)

22. Self-Incorporated Senior Corps Project

23. Service/Civic Organization

24. State Commission/Alternative Administrative Entity

25. State Education Agency

26. Statewide Association

27. Tribal Government Entity

28. Tribal Organization (non-government)

29. U.S. Territory

30. Vocational/Technical College

31. Volunteer Management Organization

32. Other

8. Check the appropriate box for type of application and enter the appropriate letter(s) in the lower boxes:

1. Check “New” if you are applying for assistance for the first time or are reapplying for a new grant cycle. (MLK Day of Service Grants select “New”)

2. Check “Continuation” if you are a grantee applying for your second or third year of funding within your 3-year project period. (Not applicable for MLK Day of Service Grants applicants)

3. Check “Amendment” if you are a grantee proposing any change in your budget or requesting a no cost extension. (Not applicable for MLK Day of Service Grants applicants)

If you are proposing an amendment to your grant, check the type of revision you are submitting. (Not applicable for MLK Day of Service Grants applicants)

1. Select “Augmentation” if you are an AmeriCorps*State grantee submitting a revised budget to incorporate a Corporation-authorized increase.

2. Select “Budget Revision” to make a change in the grant budget, including slots.

3. Select “No cost Extension” to request an extension of the grant period, and then enter the extension date requested in the blank following the checkbox. No-cost extensions can be requested only in the third year of the 3-year grant cycle and must be requested before the project period ends.

4. Select “Other,” as applicable, and specify in the blank provided.

9. Filled in for your convenience.

10. Use the following CFDA (Catalog of Federal Domestic Assistance) number for the applicable program listing:

94.007 Innovative and Demonstration Programs

11. a. Enter the title of the project

b. Enter the name of the CNCS program initiative as provided in the instructions corresponding to the NOFA for which you are applying: MLK Day of Service Grants.

12. List only the largest political entities affected (e.g., counties, and cities).

13. (See item 8)

• “New” application or “New application/previous grantee”: Enter the dates for the proposed project period.

• “Continuation” or “Amendment” application: Enter the dates of the approved project period.

14. Check the appropriate box to indicate the number of years within the grant period for which funding is being requested. Enter the amount requested or to be contributed during this budget period on the appropriate line, as shown below. The value of in-kind contributions should be included in these amounts, as applicable. For revisions (See item 8), if the action will result in a dollar change to an existing award, include only the amount of the change. For decreases, enclose the amounts in parentheses. (MLK Day of Service Grant applicants check Yr 1)

1. Federal The total amount of Federal funds being requested in the budget.

2. Applicant The total amount of the applicant share as entered in the budget.

3. Local The amount of the applicant share that is coming from local sources.

4. State The amount of the applicant share that is coming from state sources.

5. Other The amount of the applicant share that is coming from other sources.

6. Program Income The amount of the applicant share that is coming from income generated by programmatic activities.

7. Total The applicant's estimate of the total funding amount for the agreement

15. Indicate if this application is subject to review by the state "Executive Order 12372 Process" by checking the box. 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. A list of these "Single Point of Contact" entities can be found at: http://www.whitehouse.gov/omb/grants/spoc.html. Contact the Single Point of Contact to determine whether your application is subject to the state intergovernmental review process. (MLK Day of Service Grants select “No”)

1. If Yes, indicate the date a copy of your application was submitted to the state for review under the Executive Order 12372 Process

2. If No, check the appropriate box.

16. Check 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 allowances, loans, and taxes. If Yes, attach an explanation.

17. The person who signs this form must be the applicant’s authorized representative. A copy of the governing body’s authorization for this official representative to sign must be on file in the applicant’s office.

Note: Falsification or concealment of a material fact or submission of false, fictitious or fraudulent statements or representations to any department or agency of the United States Government may result in a fine or imprisonment, or both. (18 U.S. Code Section 1001)

PART I – FACESHEET

APPLICATION FOR FEDERAL ASSISTANCE							1. TYPE OF SUBMISSION: Application Non-Construction
2. DATE SUBMITTED TO CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS):		3. a. DATE RECEIVED BY STATE:      					3.b. STATE APPLICATION IDENTIFIER:      
     		4. a. DATE RECEIVED BY CNCS:      					4.b. CNCS GRANT NUMBER:      
5. APPLICANT INFORMATION
LEGAL NAME:       ORGANIZATIONAL UNIT:      					NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes):
ADDRESS (give street address, city, county, state and zip code):                  					NAME:       TELEPHONE NUMBER: (     )       -       FAX NUMBER: (     )       -       INTERNET E-MAIL ADDRESS:       WEBSITE:      
6. EMPLOYER IDENTIFICATION NUMBER (EIN):			6A. DUNS Number:		7.a. TYPE OF APPLICANT: (enter appropriate letter in box) A. State H. Independent School District B. County I. State Controlled Institution of Higher Learning C. Municipal J. Private University D. Township K. Indian Tribe E. Interstate L. Individual F. Intermunicipal M. Profit Organization G. Special District N. Private Non-Profit Organization O. Other (specify) 7.b. CNCS APPLICANT CHARACTERISTICS Enter appropriate code in each blank: ______, ______, ______, ______, ______
8 . TYPE OF APPLICATION (Check appropriate box): NEW CONTINUATION REVISION If Revision, enter appropriate letter(s) in box(es):     A. Increase Award: B. Descrease Award: C. Increase Duration: to       (enter date) D. Decrease Duration: to       (enter date) E. OTHER (specify):
					9. NAME OF FEDERAL AGENCY: Corporation for National and Community Service
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:           Name of Program ___________­__________________________________________					11. a. TITLE OF APPLICANT’S PROJECT:                  
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc.):                  					14. PERFORMANCE PERIOD: Start Date       End Date:      
13. PROPOSED PROJECT: START DATE:       END DATE:            
15. ESTIMATED FUNDING: Check applicable box: Yr 1: Yr.2: or Yr 3:						16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
a. FEDERAL	$      					ORDER 12372 PROCESS? a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
b. APPLICANT	$      					TO THE STATE EXECUTIVE ORDER 12372 PROCESSS FOR REVIEW ON:
c. STATE	$      					DATE ___________________________________ b. NO. PROGRAM IS NOT COVERED BY E.O. 12372
d. LOCAL	$      					OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
e. OTHER	$      					17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
f. TOTAL	$      					YES If “Yes,” attach an explanation. NO
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. TYPED NAME OF AUTHORIZED REPRESENTATIVE:      				b. TITLE:      				c. TELEPHONE NUMBER:      
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:								e. DATE SIGNED:

Modified Standard Form 424-NSSC (Rev. 3/03 to conform to the CNCS eGrants system)

APPENDIX B: Assurances and Certifications

Instructions

By signing and submitting this application, as the duly authorized representative of the applicant, you certify that the applicant will comply with the Assurances and Certifications described below.

a) Inability to certify

Your inability to provide the assurances and certifications listed below will not necessarily result in denial of a grant. You must submit an explanation of why you cannot do so. We will consider your explanation in determining whether to enter into this transaction. However, your failure to furnish an explanation will disqualify your application.

b) Erroneous certification or assurance

The assurances and certifications are material representations of fact upon which we rely in determining whether to enter into this transaction. If we later determine that you knowingly submitted an erroneous certification or assurance, in addition to other remedies available to the federal government, we may terminate this transaction for cause or default.

c) Notice of error in certification or assurance

You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous when submitted or has become erroneous because of changed circumstances.

d) Definitions

The terms “covered transaction”, “debarred”, “suspended”, “ineligible”, “lower tier covered transaction”, “participant”, “person”, “primary covered transaction”, “principal”, “proposal”, and “voluntarily excluded” as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. An applicant shall be considered a “prospective primary participant in a covered transaction” as defined in the rules implementing Executive Order 12549. You may contact us for assistance in obtaining a copy of those regulations.

e) Certification requirement for subgrant agreements

You agree by submitting this proposal that if we approve your application you shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by us.

f) Certification inclusion in subgrant agreements

You agree by submitting this proposal that you will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions,” provided by us, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

g) Certification of subgrant principals

You may rely upon a certification of a prospective participant in a lower-tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless you know that the certification is erroneous. You may decide the method and frequency by which you determine the eligibility of your principals. You may, but are not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.

h) Non-certification in subgrant agreements

If you knowingly enter into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, we may terminate this transaction for cause or default.

i) Prudent person standard

Nothing contained in the foregoing may be construed to require establishment of a system of records in order to render in good faith the assurances and certifications required. Your knowledge and information is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

ASSURANCES

As the duly authorized representative of the applicant, I certify, (to the best of my knowledge) and belief, 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 program costs) to ensure proper planning, management, and completion of the program 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 position 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 all rules regarding prohibited activities, including those stated in applicable application guidelines, grant provisions, and program regulations, and will ensure that no assistance made available by the Corporation will be used to support any such prohibited activities.

6. 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 statutes or regulations specified in Appendix A of OPM’s Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).

7. 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) sections 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 National and Community Service Act of 1990 or the Domestic Volunteer Services Act, as amended; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.

8. 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 program purposes regardless of federal participation in purchases.

9. 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.

10. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C 276a and 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 sub-agreements.

11. 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 the 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.

12. 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 program 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 (Clean Air) Implementation Plans under Section 176(c) of the Clean 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).

13. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C 1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.

14. 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 (16U.S.C. 469a-l et seq.).

15. 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.

16. 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.

17. 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.

18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984, as amended, and OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations.

19. Will comply with all of the requirements of Subpart C of 45 CFR Part 2542, implementing E.O. 12549, regarding restrictions on doing business with suspended, debarred and otherwise disqualified entities

20. Will comply with all of the requirements for providing a drug-free workplace on a continuing basis as set out in Subpart B of 45 CFR Part 2545, implementing sec.5151 – 5160 of the Drug-Free Workplace Act of 1988 (P.L. 100-690).

21. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, application guidelines, and policies governing this program.

CERTIFICATION

Lobbying (Activities)

As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of the applicant, I certify, to the best of my 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 of Congress in connection with the making of any federal grant, the entering into of any cooperative agreement, and the extension, renewal, amendment or modification of any federal grant, or cooperative agreement;

2. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions;

3. The undersigned shall require that the language of this certification be included in the award documents for all tiers (including subawards, subgrants, contracts under grants and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

Assurances and Certification

assurance signature: NOTE: Sign this form and include in the application.

SIGNATURE: By signing this assurances page, you certify that you agree to perform all actions and support all intentions in the Assurances section.

Organization Name: _______________________________________

Program Name: _______________________________________

Name and Title of Authorized Representative: _______________________________________

Signature: _______________________________________

Date: _______________________________________

cERTIFICATION signature: NOTE: Sign this form and include in the application.

Before you start: Before completing certification, please read the Certification Instructions.

SIGNATURE: By signing this Certification page, you certify that you agree to perform all actions and support all intentions in the Certification sections of this application. The Certification is:

Lobbying Activities

Legal Applicant: _______________________________________

Program Name: _______________________________________

Name and Title of Authorized Representative: _______________________________________

Signature: _______________________________________

Date: ____________________________________

OMB Control #: 3045-0083 Expiration Date: XX/XX/20XX

This Page Intentionally Left Blank

APPENDIX C: Performance Measurement Worksheet

Column A AmeriCorps*VISTA Project Plan	Column B Date(s)
Identify Goal to which members’ activities are directed for the full length of the project.
Activities: What are the action steps needed to accomplish this goal?
Identify any Results (outputs, intermediate outcomes, or end outcomes) related to this goal. If the result is to be measured, write “performance measure” in parentheses beside the result. For each result, identify the indicator, the targets you expect to meet, the instrument(s) you will use to measure this objective, and how you will collect the data. If you have data for this objective from prior years, report it here. Output: Output: Intermediate Outcome:

OMB Control #: 3045-0047 Expiration Date: XX/XX/20XX

APPENDIX D: SF424A Budget Instructions and Worksheet

Before You Begin: In eGrants, the preparation of a detailed budget provides the data that creates the summary budget and the budget narrative. Your detailed budget must provide a full explanation of associated costs including their purpose, justification, and the basis of your calculations. Where appropriate, your calculations should be presented in an equation format, identifying the number of persons involved with the event, the per person/unit cost, and/or the annual salary cost.

Use the Budget Worksheet as a guide as you prepare your budgets.

SUPPORT EXPENSES

Match. Describe the grantee match contribution for Section I by clearly indicating the source(s), the type of contribution (cash/in-kind), the amount (or estimate), and the intended purpose of the match. You may enter this information in any category in the Purpose-Calculation field.

1. Personnel Expenses – Include the portion of principal staff time attributed directly to the operation of the MLK Day of Service project. List each staff position and a brief statement of responsibilities for each in the ‘Position/Title’ field. For each position, also include the annual salary, and the percentage of staff time that will apply to the grant.

2. Personnel Fringe Benefits – Include costs of benefit(s) for your project staff. You can identify and calculate each benefit or show cost as a percentage of all salaries.

3. Project Staff Travel - Describe the purposes for staff travels. Costs allowable are transportation, lodging, subsistence, and other related expenses for local and outside the project area travel.

4. Equipment – Equipment is defined as tangible, non-expendable personal property having a useful life of more than one year AND an acquisition cost of $5,000 (five thousand) or more per unit (including accessories, attachments, and modifications). Include items that do not meet this definition in E. Supplies below. Purchases of equipment are limited to 10% of the total grant amount, i.e., the federal share of all budget line items. If applicable, show the unit cost and number of units you are requesting.

5. Supplies – Include the funds for the purchase of consumable supplies and materials that does not fit the definition above. You must individually list any single item costing $1,000 (one thousand) or more.

6. Contractual and Consultant Services - You may include costs for consultants related to the project’s operations. Consultants used for evaluation should be included in H. Evaluation below. Payments to individuals for consultant services under this grant may not exceed $540 per day (exclusive of any indirect expenses, travel, and supplies). Where applicable, indicate the daily rate for consultants.

7. Training - Include the costs associated with training of staff working directly on the project, especially training that specifically enhances staff project implementation and professional skills, i.e., project or financial management, team building, etc. Indicate daily rates of consultants, where applicable. You may also include costs associated with the training of service participants that will support them in carrying out their service activities, e.g., Orientation, project-specific skills such as age-appropriate tutoring, CPR, or ecosystems and the environment, etc. Indicate daily rates of consultants, where applicable.

8. Evaluation - Include costs for project evaluation activities, including additional staff time or subcontracts you did not budget under Section I A. Personnel Expenses, use of evaluation consultants, purchase of instrumentation and other costs specifically for this activity. This does not include the daily/weekly gathering of data to assess progress toward project objectives, but is a larger assessment of the impact your project is having on the community, as well as an assessment of the overall systems and project design. Indicate daily rates of consultants, where applicable.

9. Other – Allowable costs in this category may include travel to Corporation-sponsored meetings and background checks of participants if their service activities involve contact with vulnerable populations, i.e., children, the elderly, and the disabled. In addition, these costs may include office space rental (for sites where projects are operating, while national office space rental may be unallowable – check relevant OMB Circulars), utilities, and telephone and Internet expenses that are specifically used for participants, directly involve project staff, and are not part of the organizations indirect cost/admin cost. If shared with other projects or activities, you must prorate the costs equitably. List each item and provide a justification in the budget.

10. Indirect Costs

1. Definitions

Administrative costs are general or centralized expenses of overall administration of an organization that receives Corporation funds and does not include particular project costs. For organizations that have an established indirect cost rate for federal awards, administrative costs mean those costs that are included in the organization’s indirect cost rate. Such costs are generally identified with the organization’s overall operation and are further described in Office of Management and Budget Circulars A-21, A-87, and A-122 (codified respectively at 2 CFR Parts 220, 225, and 230). For organizations that do not have an established indirect cost rate for federal awards, administrative costs include:

1. costs are financial, accounting, auditing, contracting or general legal services, except in unusual cases whether they are specifically approved in writing by the Corporation as project costs;

2. costs for internal evaluation, including overall organization’s management improvement costs (except for independent and internal evaluations of the project evaluations that are specifically related to creative methods of quality improvement); and

3. costs for general liability insurance that protects the organization(s) responsible for operating a project, other than insurance costs solely attributable to the project.

Administrative costs may also include that portion of salaries and benefits of the project’s director and other administrative staff not attributable to the time spent in support of a specific project. The principles that pertain to the allocation and documentation of personnel costs are set out in the OMB cost circulars and regulations referenced above, which are incorporated in the Corporation’s regulations at 45 CFR 2541.220(b) and 2543.27.

Administrative costs do not include the following allowable expenses directly related to a project (including their operations and objectives), such as:

1. allowable direct charges for members, including living allowances, insurance payments made on behalf of members training and travel;

2. costs for staff (including salary, benefits, training and travel) who recruit, train, place or supervise members or who develop materials used in such activities, if the purpose is for a specific project objective;

3. costs for independent evaluations and any internal evaluations of the project that are related specifically to creative methods of quality improvement;

4. costs, excluding those already covered in an organization’s indirect cost rate, attributable to staff that work in a direct project support, operational, or oversight capacity, including, but not limited to: support staff whose functions directly support project activities; staff who coordinate and facilitate single or multi-site project activities; and staff who review, disseminate and implement Corporation guidance and policies directly relating to a project;

5. space, facility and communications costs that primarily support project operations, excluding those costs that are already covered by an organization’s indirect costs rate; and

6. other allowable costs, excluding those costs that are already covered by an organization’s indirect cost rate, specifically approved by the Corporation as directly attributable to a project.

2. Calculating Administrative/Indirect Costs

Federally Approved Indirect Cost Rate Method

If you have a federally approved indirect cost (IDC) rate and choose to use it, such rate will constitute documentation of your administrative costs. Specify the Cost Type for which your organization has current documentation on file, i.e., Provisional, Predetermined, Fixed, or Final indirect cost rate. Supply your approved IDC rate (percentage). It is at your discretion whether or not to use your entire IDC rate to calculate administrative costs. If you choose to claim a lower rate, please include this rate under the Rate Claimed field.

1. Determine the amount of direct costs to which you will apply the IDC rate, including both the Corporation and Grantee’s shares, as proscribed by your organization (i.e., based on salaries and benefits, total direct costs, or other). Then multiply the appropriate direct costs by the rate being claimed. This will determine the total amount of indirect costs allowable under the grant.

2. Multiply the sum of the Corporation share in Sections I and II by .0526. This is the maximum amount you can claim as the Corporation share of indirect costs.

3. Subtract the amount calculated in step 2 from the amount calculated in step 1. This is the amount the applicant can claim as grantee share for administrative costs.

Budget Worksheet

Section I. Support Expenses

1. Personnel Expenses

Position/Title	Qty	Annual Salary	% Time	Total Amount			CNCS Share	Grantee Share
Totals

B. Personnel Fringe Benefits

Item	Description	Total Amount			CNCS Share		Grantee Share
Totals

C. Travel

Purpose	Calculation	Total Amount		CNCS Share		Grantee Share
Totals

D. Equipment

Item/Purpose	Qty	Unit Cost	Total Amount		CNCS Share		Grantee Share
Totals

E. Supplies

Item	Calculation	Total Amount			CNCS Share		Grantee Share
Totals

6. Contractual and Consultant Services

Purpose	Calculation (include Daily Rate)	Total Amount		CNCS Share		Grantee Share
Totals

6. Training

Purpose	Calculation (include Daily Rate)	Total Amount		CNCS Share		Grantee Share
Totals

6. Evaluation

Purpose	Calculation (include Daily Rate)	Total Amount		CNCS Share		Grantee Share
Totals

9. Other Support Costs

Item	Total Amount			CNCS Share		Grantee Share
Totals

9. Indirect Costs

Description	Total Amount	CNCS Share	Grantee Share

K. Source of Match

Source(s), Type, Amount, Intended Purpose,

OMB Control #: 3045-0047 Expiration Date: XX/XX/20XX

APPENDIX E: Survey on Ensuring Equal Opportunity for Applicants

Survey on Ensuring

Equal Opportunity for Applicants

OMB No. 1890-0014 Exp. 1/131/2006

Federal Agency Use Only

OMB No. 3045-0047 Exp. XX/XX/20XX

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: _________________________________________________________

Grant Name: ___________________________________________CFDA Number: _____________

1. Does the applicant have 501(c)(3) status?

Yes No

2. 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

3. 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

4. Is the applicant a faith-based/religious
organization?

Yes No

5. Is the applicant a non-religious community-based organization?

Yes No

6. Is the applicant an intermediary that will manage the grant on behalf of other organizations?

Yes No

7. Has the applicant ever received a government grant or contract (Federal, State, or local )?

Yes No

8. Is the applicant a local affiliate of a national
organization?

Yes No

Survey Instructions on Ensuring Equal Opportunity for Applicant

Provide the applicant’s (organization) name and DUNS number and the grant name and CFDA number.

1. 501(c)(3) status is a legal designation provided on application to the Internal Revenue Service by eligible organizations. Some grant programs may require nonprofit applicants to have 501(c)(3) status. Other grant programs do not.

2. For example, two part-time employees who each work half-time equal one full-time equivalent employee. If the applicant is a local affiliate of a national organization, the responses to survey questions 2 and 3 should reflect the staff and budget size of the local affiliate.

3. Annual budget means the amount of money your organization spends each year on all of its activities.

4. Self-identify.

5. An organization is considered a community-based organization if its headquarters/service location shares the same zip code as the clients you serve.

6. An “intermediary” is an organization that enables a group of small organizations to receive and manage government funds by administering the grant on their behalf.

7. Self-explanatory.

7. Self-explanatory.

1 The character count includes all letters, punctuation, and spaces in a document. One double-spaced, 12-point font page equals approximately 2,000 characters.

2 “Section” refers to the different components of the application in eGrants.

3 The character count includes all letters, punctuation, and spaces in a document. One double-spaced, 12-point font page equals approximately 2,000 characters.

2