Application Guide

U. S. DEPARTMENT OF AGRICULTURE

Rural Development

Rural Utilities Service
Weather Radio Transmitter
Grant Program
Fiscal Year 2001
Contents:
Page No.
Application Form
Funding Certification
Equal Opportunity and Nondiscrimination Certification
Certificate Regarding Architectural Barriers
Certificate Regarding Flood Hazard Area Precautions
Uniform Relocation Assistance and Real Property Acquisition
Policies Act of 1970 Certification
Certification Regarding Drug-Free Workplace Requirements
Alternative I – For Grantees Other than Individuals
Certification Regarding Debarment, Suspension, and Other
Responsibility Matters – Primary Covered Transactions
Certification Regarding Lobbying for Contracts, Grants
Loans, and Cooperative Agreements
Federal Obligations Certification on Delinquent Debt
Please send completed applications should be mailed to:
Ms. Roberta D. Purcell
Telecommunications Program
Assistant Administrator
1400 Independence Avenue, SW
Stop 1590
Washington, D.C. 20250

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Weather Radio Transmitter Grant Program
Application
(Please Print or Type)

Applicant Information:
Applicant’s Legal Name:
Non-Profit Organizational Structure:
! Local or State Governmental Unit

! Federally-recognized Indian Tribe

! RUS Electric or Telecommunications
Cooperative

! Other:

Contact Person:
Title:
E-mail Address:
Phone Number:

Fax Number:

Address:

Grant Information:

Grant Funds Requested
Matching Funds
Other Supplemental Funding
Total Project Cost

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service
Site Location:
Detailed Transmitter
Description
(Including Manufacturer)

Site Name

County

State

Projected
Coverage Area*

The estimated signal coverage footprint from the transmitter must cover at least 60% of the hypothetical site area.
The hypothetical site area is the area included within a circle with a 45-mile radius around a proposed rural
transmitter site on the NOAA Weather Radio site listing, as published in the Notice of Funds Availability on
April 4, 2001.

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service
Community Need (Please provide a detailed discussion of the community’s need
for the proposed system. Attach additional sheets, if necessary.):

Environmental Impact (Please provide a description of the internal modifications
or equipment additions, the size of the site in hectares, and the general nature of
the proposed use of the facilities once the project is completed including any
hazardous materials to be used, created or discharged, any substantial amount of
air emissions, wastewater discharge, or solid waste that will be generated. Attach
additional sheets, if necessary.):

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service
Grant Limitations Per Site
Site
Name
(a)

Community
Population
(b)

Per Capita
Income*
(c)

Allowable
Grant
Percentage
(e)

Project
Cost
(d)

Matching
Fund
Percentage
(f) = (100 - e)

Eligible
Grant
Amount
(d x e)

Matching
Funds
Required
(d x f)

Allowable Grant Percentage
If Community Population is 12,000 or less and Per Capita Income is less than $36,000
If Community Population is 20,000 or less and Per Capita Income is less than $38,000
If Community Population is 50,000 or less and Per Capita Income is less than $40,000
* Obtain from the Bureau of Economic Analysis website at:

http://www.bea.doc.gov/bea/regional/reis/
** Not to exceed $80,000.

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service
Matching Funds:
Site Name

Contributor’s Name
(If Applicant, So State)

Description

Amount

Attach all binding commitments from the applicant and the tower and site owners, if other than the applicant, that
tower space and electrical power utilized as matching funds will be provided, irrespective of changes in ownership
of the facilities, without charge for the life of the transmitter. If tower and equipment building space, donated
power, communications, or standby power are utilized as matching funds, please provide the calculation of each
value in the space below:
Donated Equipment:

Donated Power:

Other:

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service
Budget:
Equipment Description

Quantity

Unit Cost

Site Name:

Total Site Cost
Site Name:

Total Site Cost
Site Name:

Total Site Cost
Site Name:

Total Site Cost
Site Name:

Total Site Cost
Total Project Costs

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Total

RUS Grant
Funds
Requested

Matching
Funds

U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Funding Certification
The __________________________________________________ (Grantee), as a prospective
recipient under the Weather Radio Transmitter Grant Program, certifies that:
a. It will execute a grant agreement containing technical and other standards satisfactory
to RUS;
b. It is unable to finance a new National Oceanic and Atmospheric Administration
Weather Radio Transmitter from its own resources, or through commercial credit at
reasonable rates and terms, or other funding sources without grant assistance.
c. The transmitter(s) covers the specified percentage of the hypothetical site area for
each of the following:
Site Name

Percentage of Hypothetical Site Area

1.
2.
3.
4.
5.

____________________________________________
(Signature)

__________________________
(Date)

____________________________________________
(Type or Print Name)

____________________________________________
(Title)

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)
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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Equal Opportunity and Nondiscrimination Certification
All grants made under the Weather Radio Transmitter Grant Program are subject to the
nondiscrimination provisions of Title VI of the Civil Rights Act of 1964, as amended, (7 CFR
Part 15); Section 504 of the Rehabilitation Act of 1973, as amended, (29 U.S.C. 901 et seq;
7 CFR Part 15b); and Age Discrimination of 1975, as amended (42 U.S.C. 6101 et seq.; 45 CFR
Part 90); and as amended by Executive Order 11375 Amending Executive Order 11246, Relating
to Equal Employment Opportunity (3 CFR, 1966, 1970 Comp., p. 684).
All recipients of financial assistance from RUS, the prospective primary participant
commits to carry out RUS’ established policy to comply with the requirements of the above laws
and executive orders to the effect that no person in the United States shall, “on the basis of race,
color, national origin, handicap, or age, be excluded from participation in, be denied the benefits
of, or be otherwise subjected to discrimination under the Weather Radio Transmitter Grant
Program.
The __________________________________________________ (Grantee)
hereby certifies that, as a prospective recipient under the said Weather Radio Transmitter Grant
Program, it will comply with the above reference laws and executive orders.

____________________________________________
(Authorized Representative’s Signature)

__________________________
(Date

____________________________________________
(Name Typed or Printed)

____________________________________________
(Title)

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)
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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Certificate Regarding Architectural Barriers
All facilities financed with RUS grants that are open to the public, or in which physically
handicapped persons may be employed or reside, must be designed, constructed, and/or altered
to be readily accessible to, and usable by handicapped persons. Standards for these facilities
must comply with the Architectural Barriers Act of 1968, as amended, 42 U.S.C. 4151 et seq.)
and with the Uniform Federal Accessibility Standards (UFAS), (Appendix A to 41 CFR subpart
101-19.6).
As a prospective primary participant recipient of financial assistance from RUS, this
organization commits to carry out RUS’ established policy to comply with the requirements of
the above referenced law to the effect that all facilities must be readily accessible to and usable
by handicapped persons.
The _______________________________________ (Grantee) hereby certifies, that, as a
prospective recipient under the Weather Radio Transmitter Grant Program, it is in compliance, or
will be in compliance upon completion of the project, with the above referenced law.

________________________
(Date)

___________________________________
(Authorized Representative’s Signature)

___________________________________
(Name Typed or Printed)

___________________________________
(Title)

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)
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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Certificate Regarding Flood Hazard Area Precautions
If the project is located in an area subject to flooding, flood insurance must be provided to the
extent available and required under the National Flood Insurance Act of 1968, as amended by the
Flood Disaster Protection Act of 1973, as amended (42 U.S.C. 4001 through 4128). If
applicable, the insurance must cover, in addition to the buildings, any machinery, equipment,
fixtures, and furnishings contained in the buildings. RUS will comply with Executive Order
11988, Floodplain Management (3 CFR, 1977 Comp., p. 117), and 7 CFR 1794.41, of this
chapter in considering the application for the project.
Please check the appropriate line below:
___ a) The project is not located in a 100 year flood plain; therefore, no Flood Insurance
is required.
___ b) The project is located in a 100 year flood plain and the required insurance is or will be
provided by:
________________________________
________________________________
________________________________
The _______________________________________ (Grantee) hereby certifies, that, as a
prospective recipient under the Weather Radio Transmitter Grant Program, it is in compliance, or
will be in compliance during construction and/or installation of equipment and upon completion
of the project, with the above referenced law.

________________________
(Date)

__________________________________
(Authorized Representative’s Signature)

__________________________________
(Name Typed or Printed)

__________________________________
(Title)

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)
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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Uniform Relocation Assistance and Real Property Acquisition
Policies Act of 1970 Certification
The _________________________________________________________ (Grantee) assures
that it will comply with the Uniform Relocation Assistance and Real Property Acquisition
Policies Act of 1970, as amended (Uniform Act), 42 U.S.C. 4601-4655, and with implementing
Federal regulations in 49 CFR Part 24 and 7 CFR Part 21.
Specifically, the ________________________________________________ (Grantee) assures
that:
Whenever Federal financial assistance is used to pay for any part of the cost of a program or
project which will result in the displacement of any person:
(a) Fair and reasonable relocation payments and assistance shall be provided to or for
displaced persons in accordance with sections 202, 203, and 204 of the Uniform
Act;
(b) Relocation assistance programs offering the services described in section 205 of the
Uniform Act shall be provided to displaced persons; and
(c) Within a reasonable period of time prior to displacement, comparable replacement
dwellings will be available to displaced persons in accordance with section 205(c)
(3) of the Uniform Act.

___________________
Date

______________________________________________________
(Authorized Representative’s Signature)

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)
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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Certification Regarding Drug-Free Workplace Requirements
Alternative I – For Grantees Other than Individuals
This certification is required by the regulations implementing Sections 5151-5160 of the Drug-Free
Workplace Act of 1988 (P.L. 100-690, Title V, Subtitle D; 41 U.S.C. 701 et seq.), 7 CFR Part 3017,
Subpart F, Section 3017.600, Purpose. The January 31, 1989, regulations were amended and published as
Part II of the May 25, 1990, Federal Register (pages 21681-21691). Copies of the regulations may be
obtained by contacting the Department of Agriculture agency offering the grant.
ALTERNATIVE I
A. The grantee certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the grantee’s workplace and
specifying the actions that will be taken against employees for violation of such prohibition;
(b) Establishing an ongoing drug-free awareness program to inform employees about:
(1)
(2)
(3)
(4)

The dangers of drug abuse in the workplace;
The grantee’s policy of maintaining a drug-free workplace;
Any available drug counseling, rehabilitation, and employee assistance programs; and
The penalties that may be imposed upon employees for drug abuse violations occurring in
the workplace;

(c) Making it a requirement that each employee to be engaged in the performance of the grant be
given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of
employment under the grant, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than 5 calendar days after such conviction;
(e) Notifying the Agency in writing, within 10 calendar days after receiving notice under
subparagraph (d) (2) from an employee or otherwise receiving actual notice of such
conviction. Employers of convicted employees must provide notice, including position title, to
every grant officer on whose grant activity the convicted employee was working, unless the
Federal agency has designated a central point for the receipt of such notices. Notice shall include
the identification number(s) of each affected grant;
(f) Taking one of the following actions, within 30 calendar days of receiving notice under
subparagraph (d)(2), with respect to any employee who is so convicted:

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

(1) Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended;
or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health, law
enforcement, or other appropriate agency; and
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation
of paragraphs (a), (b), (c), (d), (e), and (f).
B. The grantee may insert in the space provided below the site(s) for the performance of work done in
connection with the specific grant:

Place of Performance:

______________________________________________________________________________
Street Address
City

______________________________________________________________________________
County
State
Zip Code

____ Check if there are workplaces on file that are not identified here.
______________________________________________________________________________
Organization Name

______________________________________________________________________________
Authorized Representative’s Signature
Date

______________________________________________________________________________
Name Typed or Printed

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Certification Regarding Debarment, Suspension, and Other
Responsibility Matters – Primary Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 7 CFR Part 3017, Section 3017.510, Participants’ Responsibilities. The regulations were
published as Part IV of the January 30, 1989, Federal Register (pages 4722-4733). Copies of the
regulations may be obtained by contacting the Department of Agriculture agency offering the proposed
transaction.
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its
principals:
(a) are not presently debarred, suspended, proposed for Debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) have not within a 3-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or
contract under a public transaction; violation of Federal or State antitrust statutes or commission
of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
(c) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b)
of this certification; and
(d) have not within a 3-year period preceding this application/proposal had one or more public
transactions (Federal, State, or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.

______________________________________________________________________________
Organization Name
______________________________________________________________________________
Authorized Representative’s Signature
Date
______________________________________________________________________________
Name Typed or Printed

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)
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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Certification Regarding Lobbying 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 or loan, the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance
with its instructions. (Copies of this form may be obtained from RUS.)
(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.

______________________________________________________________________________
Organization Name
______________________________________________________________________________
Authorized Representative’s Signature
Date
______________________________________________________________________________
Name Typed or Printed
(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)

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U.S. DEPARTMENT OF AGRICULTURE

Rural Utilities Service

Federal Obligations Certification on Delinquent Debt
IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?

YES

NO

Note: Example of debts include, but are not limited to, delinquent taxes, guaranteed or direct
government loans (more than 31 days past due) and other administrative debts.
If Yes, provide explanatory information.

APPLICANT CERTIFICATION
FEDERAL COLLECTION POLICIES FOR COMMERCIAL DEBT
The Federal Government is authorized by law to take any or all of the following actions in the
event that a borrower’s loan payments become delinquent or the borrower defaults on its loan:
(1) Report the borrower’s delinquent account to a credit bureau; (2) Assess additional interest
and penalty charges for the period of time that payment is not made; (3) Assess charges to
cover additional administrative costs incurred by the Government to service the borrower’s
account; (4) Offset amounts owed to the borrower under other Federal programs; (5) Refer the
borrower’s debt to the Internal Revenue Service for offset against any amount owed to the
borrower as an income tax refund; (6) Refer the borrower’s account to a private collection
agency to collect the amount due; and (7) Refer the borrower’s account to the Department of
Justice for litigation in the courts.
All of these actions can and will be used to recover any debts owed when it is determined to be
in the interest of the Government to do so.
Certification
I have read and understand the actions the Federal Government can take in the event that
I fail to meet my scheduled payments in accordance with the terms and conditions of my
agreements.
Signed:
Title:
Company:
Date:

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the Weather Radio Transmitter Grant
Program.)
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