School Wellness Policy Cooperative Agreement

Uniform Grant Application for Non-Entitlement Discretionary Grants

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0512 can be found here:

Documents and Forms

Document Name Document Type
LWP RFA 6-19-2014.docx www.grants.gov Other-Request for Application
Terms and Conditions - FINAL.docx Terms and Conditions IC Document
AD1049-F-05-90.pdf CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) IC Document
AD1050-F-01-92.pdf CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) IC Document
RR_FedNonFedBudget-V1.1.pdf Research and Related Budget _FedNonFedBudget IC Document
RR_SubawardBudget_1_3-V1.3.pdf R&R Sub Award Budget IC Document
SF424_2_1-V2.1.pdf Application for Federal Assistance IC Document
sflll.pdf Disclosure of Lobbying Activities IC Document
Request to OMB to Use 0584-0512 (Local Child Nutrition Wellness Grant) 7-11-14.docx Generic Clearance Justification Memo IC Document
0512 LWP Grant Program_Supporting Statement 6-20-14.docx Local Wellness Program Generic Supporting Statement IC Document
SF-425 screenshot July 2013.docx SF 425 FEDERAL FINANCIAL REPORT IC Document
AD1047-F-01-92.PDF Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions IC Document
AD1048-F-01-92.PDF Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions IC Document
AD-1052.pdf CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS, STATE AND STATE AGENCIES IC Document

Information Collection (IC) Details

IC Title:	School Wellness Policy Cooperative Agreement	Agency IC Tracking Number:	Local Wellness

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Request for Application			LWP RFA 6-19-2014.docx	www.grants.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	21	21
Annual IC Time Burden (Hours)	430	430
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Terms and Conditions	Terms and Conditions - FINAL.docx	06/16/2014
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS)	AD1049-F-05-90.pdf	06/19/2014
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS)	AD1050-F-01-92.pdf	06/19/2014
Research and Related Budget _FedNonFedBudget	RR_FedNonFedBudget-V1.1.pdf	06/20/2014
R&R Sub Award Budget	RR_SubawardBudget_1_3-V1.3.pdf	06/20/2014
Application for Federal Assistance	SF424_2_1-V2.1.pdf	06/20/2014
Disclosure of Lobbying Activities	sflll.pdf	06/20/2014
Generic Clearance Justification Memo	Request to OMB to Use 0584-0512 (Local Child Nutrition Wellness Grant) 7-11-14.docx	07/11/2014
Local Wellness Program Generic Supporting Statement	0512 LWP Grant Program_Supporting Statement 6-20-14.docx	06/20/2014
SF 425 FEDERAL FINANCIAL REPORT	SF-425 screenshot July 2013.docx	07/02/2014
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions	AD1047-F-01-92.PDF	07/15/2014
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions	AD1048-F-01-92.PDF	07/15/2014
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS, STATE AND STATE AGENCIES	AD-1052.pdf	07/15/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.