Form 1122-0001 Certification of Compliance with the Statutory Eligibili

U.S. Department of Justice

O ffice of Justice Programs

Office on Violence Against Women

Certification of Compliance with the Statutory Eligibility

Requirements of the Violence Against Women Act as Amended,

STOP Formula Grant Program

Applicants should refer to the regulations cited below for further information regarding the certifications to which they are required to attest. Applicants also should review the instructions for certification included in the program regulations before completing this form. Signature on this form certifies that the state is qualified to receive the funds and provides for compliance with relevant requirements under 28 CFR Part 90 and 42 U.S.C 3796gg through 3796gg-5 and 3796gg-8. The certifications shall be treated as a material representation of fact upon which the Department of Justice will rely if it determines to award the covered transaction, grant, or cooperative agreement.

Upon complying with the application requirements set forth in this Application Guide, any state shall be qualified for funds provided under the Violence Against Women Act upon certification that:

(1) the funds will be used only for the statutory purposes described in 42 U.S.C. § 3796gg (a) and (b);

(2) grantees and subgrantees will develop plans for implementation and will consult and coordinate with nonprofit, nongovernmental victim services programs, including sexual assault and domestic violence victim services programs and describe how the state will address the needs of underserved populations;

(3) the amount granted will be allocated, without duplication, as follows: not less than 25 percent for law enforcement, not less than 25 percent for prosecutors, not less than 30 percent for nonprofit, nongovernmental victim services programs (of which at least 10 percent will be distributed to culturally specific community-based organizations), and not less than 5 percent for state and local courts; and

(4) any federal funds received under this subchapter will be used to supplement, not supplant, nonfederal funds that would otherwise be available for activities funded under this chapter.

In addition, as required by 42 U.S.C. 3796gg-4, 3796gg-5, and 3796gg-8 and implemented at 28 CFR Part 90:

(1) Forensic Medical Examination Payment Requirement for Victims of Sexual Assault

(a) A state, Indian tribal government, or unit of local government shall not be entitled to funds unless the state, Indian tribal government, unit of local government, or another governmental entity incurs the full out-of-pocket costs of forensic medical exams for victims of sexual assault.

(b) A state, Indian tribal government, or unit of local government shall be deemed to incur the full out-of- pocket cost of forensic medical exams for victims of sexual assault if any government entity:

(1) provides such exams to victims free of charge to the victim;

(2) arranges for victims to obtain such exams free of charge to the victims; or

(3) reimburses victims for the cost of such exams if

(i) the reimbursement covers the full cost of such exams, without any deductible requirement or limit on the amount of a reimbursement;

(ii) the reimbursing governmental entity permits victims to apply for reimbursement for not less than one year from the date of the exam;

(iii) the reimbursing governmental entity provides reimbursement not later than 90 days after written notification of the victim’s expense; and

(iv) the state, Indian tribal government, unit of local government, or reimbursing governmental entity provides information at the time of the exam to all victims, including victims with limited or no English proficiency, regarding how to obtain reimbursement.

(c) A State or Indian tribal government may use STOP grant funds to pay for forensic medical exams performed by trained examiners for victims of sexual assault, except that such funds may not be used to pay for forensic medical exams by any State, Indian tribal government, or territorial government that requires victims of sexual assault to seek reimbursement for such exams from their insurance carriers.

(d) As of the effective date for compliance with 42 U.S.C. 3796gg-4(d), no State, Indian tribal government, or territorial government may require a victim of sexual assault to participate in the criminal justice system or cooperate with law enforcement in order to be provided with a forensic medical exam, or to be reimbursed for charges incurred on account of such an exam.

(2) Filing Costs for Criminal Charges and Protection Orders

A state, Indian tribal government, or unit of local government will not be entitled to funds unless it

certifies that its laws, policies, and practices do not require, in connection with the prosecution of any misdemeanor or felony domestic violence offense, or in connection with the filing, issuance, registration, or service of a protection order, or a petition for a protection order, to protect a victim of domestic violence, stalking, or sexual assault, that the victim bear the costs associated with the filing of criminal charges against the offender, or the costs associated with the filing, issuance, registration, or service of a warrant, protection order, petition for a protection order, or witness subpoena, whether issued inside or outside the state, tribal, or local jurisdiction.

(3) Judicial Notification

A State or unit of local government shall not be entitled to funds under this part unless the State or unit of local government--

(a) certifies that its judicial administrative policies and practices include notification to domestic violence offenders of the requirements delineated in section 922(g)(8) and (g)(9) of title 18, United States Code, and any applicable related Federal, State, or local laws; or

(b) gives the Attorney General assurances that its judicial administrative policies and practices will be in compliance with the requirements of subparagraph (A) within the later of—

(1) the period ending on the date on which the next session of the State legislature ends; or

(2) January 5, 2009.

(4) Polygraph Testing Prohibition

(a) In order to be eligible for grants under this part, a State, Indian tribal government, territorial government, or unit of local government shall certify that, not later than January 5, 2009, their laws, policies, or practices will ensure that no law enforcement officer, prosecuting officer or other government official shall ask or require an adult, youth, or child victim of an alleged sex offense as defined under Federal, tribal, State, territorial, or local law to submit to a polygraph examination or other truth telling device as a condition for proceeding with the investigation of such an offense.

(b) Under 42 U.S.C. 3796gg-8(b), the refusal of a victim to submit to a polygraph or other truth telling examination shall not prevent the investigation, charging, or prosecution of an alleged sex offense by a state, Indian tribal government, territorial government, or unit of local government.

______________________________________________________________________________

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with above certifications.

______________________________________________________________________________

Typed Name of Authorized Representative Title Telephone Number

______________________________________________________________________________

Signature of Authorized Representative Date Signed

______________________________________________________________________________

Agency Name

Public Reporting Burden Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated average time to complete and file this form is 60 minutes per form. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 800 K Street, NW, Washington, DC 20530.