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pdfCOPS Application
Attachment to SF-424
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Standard Application Forms
COPS Application Attachment to SF-424
OMB Control Number: 1103-0098
SECTION 1:COPS PROGRAM REQUEST
Expiration Date: 05/31/2013
Federal assistance is being requested under the following COPS program:
Select the COPS grant program for which you are requesting federal assistance. A separate application must be
completed for each COPS program for which you are applying. Please ensure that you read, understand, and agree
to comply with the applicable grant terms and conditions as outlined in the COPS Application Guide before finalizing
your selection.
ONLY ONE PROGRAM OPTION MAY BE CHECKED
Child Sexual Predator Program
Targeted - Technology Program
Community Policing Development
Targeted - Methamphetamine Initiative
COPS Hiring Program
Targeted - Safe Schools Initiative
Secure Our Schools
SECTION 2: AGENCY ELIGIBILITY INFORMATION
To be eligible to apply for the 2012 CHP, your agency must commit to at least one of the following:
1. Hire new, additional officer positions AND the officer(s) hired MUST be military veteran(s). A department must hire
additional positions on or after the official grant award start date, above its current budgeted (funded) level of sworn officer
positions, and otherwise comply with the non-supplanting requirements as described in detail in the Grant Owner’ Manual. In
addition, the new hire officer must be a military veteran.
2. Rehire officers who have already been laid off (at the time of application) as a result of state, local, or tribal budget cuts.
3. Rehire officers who are (at time of application) currently scheduled to be laid off on a specific future date as a result of state,
local, or tribal budgets cuts.
Do you wish to continue with your application? Yes or No
If no, please indicate why your agency will not apply for funding (check all that applies):
Or
If no, please identify the main reason your agency will not apply for funding:
1.
2.
3.
4.
5.
Unable to meet local match requirement , but self-determined that we would not qualify for a wavier
Unable to afford the retention requirement
Unwilling to commit to hire a military veteran
Applicant pool is too competitive
Other
Name and date
Electronic signature of the person indicating NO (similar in format to the assurances signature)
A. Type of Agency (select one)
Non-Law Enforcement
Law Enforcement
From the list below, please select the type of agency which best describes the applicant.
Law Enforcement Entities
Select One...
Non-Law Enforcement Entities Select One...
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2A. CHP Eligibility Questions
In this section, we will ask you several questions about your law enforcement agency operations and authority to
determine your eligibility to apply for a COPS Hiring Program (CHP) grant. Please note that CHP applicants must
have a police department which is operational as of the (mm/dd/yyyy) date of this application, or receive services
through a new or existing contract for law enforcement services. Applicants must also maintain primary law
enforcement authority for the population to be served.
Additionally, if funds under this program are to be used as part of a written contracting arrangement for law
enforcement services (e.g., a town which contracts with a neighboring sheriff's department to receive services), the
government agency wishing to receive law enforcement services must be the legal applicant in this application
(although we will ask you to supply some information about the contract service provider later).
Part I. Law Enforcement Agency Operations
A law enforcement agency is established and operational if the jurisdiction has passed authorizing legislation and it
has a current operating budget.
Q1) Is your agency established and currently operational?
Select One...
Q2) Which of the following best describes your agency (check one)?
We are planning to establish or begin operations as a newly authorized law enforcement agency
If selected, proceed to Q3a and Q3b
We are planning to re-establish and resume operations for a previously operational law enforcement agency
If selected, proceed to Q3b
Q3a) Has your jurisdiction passed legislation which authorizes the creation of a new law enforcement agency?
Select One...
Q3b) Will your law enforcement agency be operational as of mm/dd/yyyy (application close date)?
Select One...
Part II. Contracting to Receive Law Enforcement Services
Q1) If awarded, does your agency plan to use funds awarded under this grant to establish or supplement a written
contract for law enforcement services (e.g., a town contracting for services with a nearby sheriff's department)?
Select One...
[If yes to Q1, text below plus Q2 will display]
An agency may apply for funds under this program to be used as part of a written contracting arrangement for law
enforcement services (e.g., a town which contracts with a neighboring sheriff's department to receive services).
However, the agency wishing to receive law enforcement services must be the legal applicant in this application
(although we will ask you to supply some information about the contract service provider later).
Important Note: Two entities involved in a contracting relationship may not separately apply for funding to support
the same officer position(s). For more information about contracting arrangements, please click here [Link to take
applicant to Guide Instructions re: contracting]
Q2) Is the legal applicant listed in this COPS Hiring Program (CHP) application and on the SF-424 the entity that
will be receiving law enforcement services?
Select One...
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Q3) What is the legal name of the law enforcement agency that will be providing law enforcement services to your
jurisdiction?
[proceed to next section]
Part III. Law Enforcement Agency Authority
An agency with primary law enforcement authority is defined as the first responder to calls for service for all types
of criminal incidents within its jurisdiction. Agencies are not considered to have primary law enforcement authority
if they only: respond to or investigate specific type(s) of crime(s); respond to or investigate crimes within a
correctional institution; serve warrants; provide courthouse security; transport prisoners; and/or have cases
referred to them for investigation or investigational support.
Q1) Based on the definition above, does your agency have primary law enforcement authority? [Or, if contracting to
receive services, does the agency that will be providing law enforcement services have primary law enforcement
authority for the population to be served?]
Select One...
Questions for a subset of applicants [Sheriff, County Police, State Police, Regional PD, Public University, Private
University, Natural Resources Police, Transit Police, Public Housing Police, Attorney/Court, Multijurisdictional
Task Force, Consortium, Constable, Marshals, Corrections]
Is your agency the first responder to all types of criminal incidents within your jurisdiction?
Select One...
Agencies with jurisdiction limited only to correctional institututes and/or courthouse settings are not eligible under
this program. Is your agency the first responder to citizen-initiated calls for service outside of a correctional institute
and/or courthouse setting?
Select One...
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2B: SOS Eligibility Questions
[All SOS Applicants]
1. Was this grant application prepared after consultation with individuals not limited to law enforcement officers
(such as school violence researchers, child psychologists, social workers, teachers, principals, and other school
personnel)?
Yes
No
2. Was this application prepared in a manner consistent with a comprehensive approach to preventing school violence?
Yes
No
3. Was this application individualized to the needs of each school at which those improvements are to be made?
Yes
No
4. Does your agency have primary law enforcement authority for the schools/school districts targeted through this grant
proposal?
Yes
No
Yes
5. Are the schools/school districts targeted through this grant proposal all primary or secondary schools (i.e.,
kindergarten through 12th grade)?
Yes
Yes
No
6. Do these schools all teach the basic school curriculum (e.g., math, science, reading)?
Yes
Yes
No
7. Will the funds awarded solely benefit the primary or secondary schools targeted through this grant proposal?
Yes
Yes
No
[Subset 1 Municipal Police/County Police/Sheriff’s/State Police Agency, Tribal Police etc.
(any agency other than school district police department and university/college)]
8. Is your agency partnering with a school/school district?
Yes
No
[Subset 2 School District Police]
8. Is your agency a school district which through authorization by its state and/or local legislative authority has its own
police department separate from the local sheriff’s, county police, or municipal police agency?
Yes
Yes
No
[Subset 3 Public or Private University/College Police]
8. Is your agency a university or college which has a primary or secondary school on its campus?
Yes
Yes
No
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Standard Application Forms
SECTION 3: GENERAL AGENCY INFORMATION
A. Applicant ORI Number:
The ORI number is assigned by the FBI and is your agency's unique identifier. The COPS Office uses the first seven
characters of this number. The first two letters are your state abbreviation, the next three numbers are your county's
code, and the next two numbers identify your jurisdiction within your county. If you do not currently have an ORI
number, the COPS Office will assign one to your agency for the purpose of tracking your grant.ORI numbers assigned
to agencies by the COPS Office may end in “ZZ.”
Check here if your agency has not been assigned an ORI number.
B. Applicant Data Universal Numbering System (DUNS) Number:
A Data Universal Numbering System (DUNS) number is required prior to submitting this application. A DUNS
number is a unique nine or thirteen digit sequence recognized as the universal standard for identifying and keeping
track of entities receiving federal funds. For more information about how to obtain a DUNS number, please refer to
the "How to Apply" section of the COPS Application Guide.
C. Central Contractor Registration (CCR)
All applicants (other than individuals) must be registered in the Central Contractor Registration (CCR) database prior
to submitting this application. Applicants must also maintain an active CCR registration with current information at
all times during the grant application process and, if awarded, the grant award period. The CCR database is the
repository for standard information about federal financial assistance applicants, recipients, and sub-recipients. For
more information about how to register with the CCR, please refer to the "How to Apply" section of the COPS
Application Guide. Please note that applicants must update or renew their CCR at least once per year to maintain an
active status.
Your CCR Registration is set to expire on
Note: If your CCR registration is set to expire prior to September 30, 2011, please renew your CCR Registration prior to completing this application. Contact
the CCR Service Desk at 866-606-8220 or view/update your registration information at https://www.bpn.gov/ccr/default.aspx.
D. Geographic Names Information System (GNIS) ID:
Please enter your Geographic Names Information System (GNIS) Identification Number. This is a unique ID assigned
to all geographic entities by the U.S. Geological Survey. To look up your GNIS Feature ID, please go to the website:
http://geonames.usgs.gov/domestic/index.html. For more information about how to obtain a GNIS number, please refer
to the “How to Apply” section of the COPS Application Guide.
E. Cognizant Federal Agency: Select One...
Select the legal applicant’s Cognizant Federal Agency. A Cognizant Federal Agency, generally, is the federal agency
from which your jurisdiction receives the most federal funding. Your Cognizant Federal Agency also may have been
previously designated by the Office of Management and Budget. Applicants that have never received federal funding
should select the “Department of Justice” as the Cognizant Federal Agency.
F. Fiscal Year:
to
(mm/dd)
Enter the month and day of the legal applicant's fiscal year.
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G. Law Enforcement Agency Sworn Force Information
1. Enter the Fiscal Year Budgeted Sworn Force Strength for the current fiscal year below. The budgeted number of
sworn officer positions is the number of sworn positions funded in your agency’s budget,including funded but frozen
positions, as well as state, Bureau of Indian Affairs, and/or locally funded vacancies. Do not include unfunded
vacancies or unpaid/reserve officers.
a. Number of officers funded in agency’s current fiscal year budget:
Full-Time:
Part-Time:
H. Civilian Staffing
1. Number of civilian positions funded in agency's current fiscal year budget:
a. Number of officers funded in agency’s current fiscal year budget:
Full-Time:
Part-Time:
(Civilians/(Civilians + Officers))
%
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SECTION 4: EXECUTIVE INFORMATION
Note: Listing individuals without ultimate programmatic and financial authority for the grant could delay the review of
your application, or remove your application from consideration.
A. Law Enforcement Executive/Agency Executive Information:
For Law Enforcement Agencies: Enter the law enforcement executive’s name and contact information. This is the
highest ranking law enforcement official within your jurisdiction(e.g., Chief of Police, Sheriff, or equivalent).
For Non-Law Enforcement Agencies: Enter the highest ranking individual in the applicant agency (e.g., CEO,
President, Chairperson, Director)who has the authority to apply for this grant on behalf of the applicant agency. If the
grant is awarded, this position would ultimately be responsible for the programmatic implementation of the award.
[Displayed If Contracting Law Enforcement Services]
Your agency previously indicated that if awarded, this grant would be used in a written contracting arrangement to
receive law enforcement services (e.g., a town which is contracting with a neighboring sheriff’s department to receive
services). Therefore, for question 4A, please provide the executive information for the agency which will be providing
the law enforcement services under this grant (e.g., Sheriff). For question 4B, please provide executive information for
the government agency which will be receiving the law enforcement services under this grant (i.e., Mayor, City
Manager, etc.).
Title: Select One...
Interim/Acting:
First Name:
MI
:
Agency Name:
Last Name:
Suffix:
Street Address 1:
Street Address 2:
City:
Telephone:
State:
Fax:
Zip Code:
E-mail:
B. Government Executive/Financial Official Information:
For Government Agencies: Enter the government executive’s name and contact information. This is the highest
ranking official within your jurisdiction (e.g., Mayor, City Administrator, or equivalent).
For Non-Government Agencies: Enter the name and contact information of the financial official who has the
authority to apply for this grant on behalf of the applicant agency (e.g., Treasurer). If the grant is awarded, this
position would ultimately be responsible for the financial management of the award. Please note that information for
non-executive positions (e.g., clerks, trustees, etc.) is not acceptable.
Title: Select One...
Interim/Acting:
First Name:
MI:
Last Name:
Suffix:
Agency Name:
Street Address 1:
Street Address 2:
City:
Telephone:
State:
Fax:
E-mail:
Zip Code:
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C. CAP Contact Information:
Cap Contact: Enter the Cap Contact's name and contact information.
Title: Select One...
Interim/Acting:
First Name:
MI:
Last Name:
Suffix:
Agency Name:
Street Address 1:
Street Address 2:
City:
Telephone:
State:
Fax:
E-mail:
Zip Code:
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[Section 5A below only applies if CHP is the selected program]
SECTION 5A: COPS HIRING PROGRAM OFFICER REQUEST
Part I
Enter the Fiscal Year Actual Sworn Force Strength as of the date of this application. The actual number of sworn
officer positions is the actual number of sworn positions employed by your agency as of the date of this application.Do
not include funded but currently vacant positions or unpaid positions.
a. Number of officers employed by your agency as of the date of this application:
Full-Time:
Part-Time:
[If contracting, only question below is displayed]
1. Enter the Fiscal Year Actual Sworn Force Strength for officers your agency currently has under contract for law
enforcement services as of the date of this application. The actual number of sworn officer positions is the actual
number of sworn officers under all current contracts as of the date of this application. Do not include funded but
currently vacant positions or unpaid positions.
a. Number of officers deployed by your agency as of the date of this application:
Full-Time:
Part-Time:
For FY 2012, COPS Hiring Program (CHP) applicants are eligible to apply for the number of officers equal to 5% of
their actual sworn force strength up to a maximum of 10 officers with a minimum of one (1) officer per agency. Based
on the information provided in this application, your agency is eligible to apply for up to <>
officer position(s).
FY 2012 CHP grant funds cover 75 percent of the approved entry-level salary and fringe benefits of each newly-hired
and/or rehired, full-time sworn career law enforcement officer for three years (36 months) up to $125,000 per officer
position. CHP grant funding will be based on your agency's current entry-level salaries and fringe benefits for fulltime sworn officers.
How many entry-level, full-time officer positions is your agency requesting in this application?
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Next, your agency must allocate the number of positions requested under each of the three hiring categories described
below based on your agency's current needs at the time of this application. Please be mindful of the initial three-year
grant period, and your agency's ability to fill and retain the officer positions awarded, while following your agency's
established hiring policies and procedures. CHP grant awards will be made for officer positions requested in each of
the three hiring categories, and grantees are required to use awarded funds for the specific categories awarded.
It is imperative that your agency understand that the COPS statutory nonsupplanting requirement mandates that grant
funds may only be used to supplement (increase) a grantee's law enforcement budget for sworn officer positions and
may not supplant (replace) state, local, or tribal funds that a grantee otherwise would have spent on officer positions if
it had not received a grant award. This means that if your agency plans to:
(a) Hire new officer positions (including filling existing vacancies that are no longer funded in your agency's budget).
If awarded under this category, a department must hire a military veteran as defined in the 2012 CHP Application
Guide. It must also hire these new additional positions on or after the official grant award start date, above its current
budgeted (funded) level of sworn officer positions, and otherwise comply with the nonsupplanting requirement as
described in detail in the Grant Owner's Manual.
(b) Rehire officers who have already been laid off (at the time of the updated application) as a result of state, local, or
tribal budget cuts: It must rehire the officers on or after the official grant award start date, maintain documentation
showing the date(s) that the positions were laid off and rehired, and otherwise comply with the nonsupplanting
requirement as described in detail in the Grant Owner’s Manual.
(c) Rehire officers who are (at the time of the updated application) currently scheduled to be laid off on a future date
as a result of state, local, or tribal budget cuts: It must continue to fund the officers with its own funds from the grant
award start date until the date of the scheduled lay-off (for example, if the CHP award start date is September 1 and
the lay-offs are scheduled for November 1, then the CHP funds may not be used to fund the officers until November
1, the date of the scheduled lay-off); identifying the number and date(s) of the scheduled lay-off(s) in this application
(see below); maintain documentation showing the date(s) and reason(s) for the lay-off; and otherwise comply with
the nonsupplanting requirement as described in detail in the Grant Owner’s Manual. [Please note that as long as your
agency can document the date that the lay-off(s) would occur if CHP funds were not available, it may transfer the
officers to the CHP funding on or immediately after the date of the lay-off without formally completing the
administrative steps associated with a lay-off for each individual officer.]
Documentation that may be used to prove that scheduled lay-offs are occurring for local economic reasons that are
unrelated to the availability of CHP grant funds may include (but are not limited to) council or departmental meeting
minutes, memoranda, notices, or orders discussing the lay-offs; notices provided to the individual officers regarding the
date(s) of the lay-offs; and/or budget documents ordering departmental and/or jurisdiction-wide budget cuts. These
records must be maintained with your agency’s CHP grant records during the grant period and for three years
following the official closeout of the CHP grant in the event of an audit, monitoring, or other evaluation of your grant
compliance.
If your agency's request is funded, it will have the opportunity after the award announcement to request a grant
modification to move awarded funding into the category or categories that meet your agency's law enforcement needs
at that time (including updating the dates of future scheduled lay-offs).
If you need additional information regarding requesting a modification, please contact the COPS Office Response
Center at 1-800-421-6770.
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Category A: New, additional officer positions (including to fill existing vacancies no longer funded in your agency’s
budget). Please note that any officer hired under this category must be a military veteran as defined in the 2012 CHP
Application Guide.
Category A Request: <>
Category B: Rehire officers already laid off (at the time of the application) as a result of state or budget reductions.
Category B Request: <>
Category C: Rehire officers scheduled to be laid off (at the time of the application) on a specific future date as a result
of state or local budget reductions.
Category C Request: <>
(total)
We also need some information about when the layoff of officers in this category is scheduled to
occur. In the space below, please indicate when the officer(s) specified in this category are
scheduled to be laid off.
Number of officers:
Date these officers are scheduled to be laid off:
Number of officers:
Date these officers are scheduled to be laid off:
Number of officers:
Date these officers are scheduled to be laid off:
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Standard Application Forms
Part 2 [Section hidden unless Category C in previous section not null]
Since your agency plans to use CHP funds to rehire officers who are currently scheduled to be laid off on a future date
(under Category C above), please certify (by checking the appropriate boxes) to the following:
Certification:
My agency has and will maintain documentation showing the date(s) of the scheduled lay-off(s) and demonstrating
that the scheduled lay-off(s) is/are occurring for fiscal reasons that are unrelated to the availability or receipt of
CHP grant funds.
My agency will use its own funds to continue funding these officers until the scheduled date(s) of the lay-off(s)
and will use CHP funds to rehire these officers only on or after the scheduled date of the lay-off(s).
My agency recognizes that the CHP program provides funding based on our entry-level salary and benefits
package and that any additional costs for rehired officers beyond entry-level are our responsibility to pay with
other sources of funding.
If an applicant receives an award, and needs to change the hiring categories after receiving the award, it must request a
post-award grant modification to change the categories of hiring and receive prior approval before spending CHP
funding by calling the COPS Office Response Center at 1-800-421-6770.
Part 3
As noted previously, the number of officers an applicant can request under the COPS Hiring Program in 2011 is
capped. However, the COPS Office is interested in learning more about the overall need for officer positions within
your department. Therefore, if no officer caps were in place, what is the total number of officers that your agency
would be requesting in this application?
[Section 5B below applies only if CSPP is the selected program]
SECTION 5B: CHILD SEXUAL PREDATOR PROGRAM (CSPP) OFFICER REQUEST
1. Is your agency requesting funding in this application for full-time, entry-level sworn officer positions?
Yes
No
2. How many full-time, entry-level sworn officer positions is your agency requesting in this application?
[Note: you will be asked in Section 14 to provide detailed entry-level officer salary and benefit costs]
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Non-hiring Applicants Only
SECTION 6A: LAW ENFORCEMENT & COMMUNITY POLICING STRATEGY
COPS Office grants must be used to reorient the mission and activities of law enforcement agencies through initiating
community policing or enhancing their involvement in community policing. If awarded funds, your responses to this
section will constitute your agency’s community policing plan under this grant. Your organization may be audited or
monitored to ensure that it is initiating or enhancing community policing in accordance with this plan. The COPS
Office may also use this information to understand the needs of the field, and potentially provide for training, technical
assistance, problem solving and community policing implementation tools.
We understand that your community policing needs may change during the life of your grant (if awarded), and minor
changes to this plan may be made without prior approval from the COPS Office. We also recognize that this plan
may incorporate a broad range of possible community policing strategies and activities, and that your agency may
implement particular community policing strategies from the plan on an as-needed basis throughout the life of the
grant. If your agency’s community policing plan changes significantly, however, you must submit those changes
in writing to the COPS Office for approval. Changes are “significant” if they deviate from the range of possible
community policing activities identified and approved in this original community policing plan submitted with your
application.
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Community Policing Definition Framework
The following is the COPS Office definition of community policing that emphasizes the primary components of
community partnerships, organizational transformation, and problem solving.
Community policing is a philosophy that promotes organizational strategies, which support the systematic use of
partnerships and problem-solving techniques, to proactively address the immediate conditions that give rise to public
safety issues, such as crime, social disorder, and fear of crime.
The COPS Office has completed the development of a comprehensive community policing self-assessment tool for use
by law enforcement agencies. Based on this work, we have developed the following list of primary sub-elements of
community policing. Please refer to the COPS Office website (www.cops.usdoj.gov) for further information regarding
these sub-elements.
Community Partnerships:
Collaborative partnerships between the
law enforcement agency and the
individuals and organizations they serve
to both develop solutions to problems
and increase trust in police.
Organizational Transformation:
The alignment of organizational
management, structure, personnel and
information systems to support
community partnerships and proactive
problem-solving efforts.
Problem Solving:
The process of engaging in the proactive
and systematic examination of identified
problems to develop effective responses
that are rigorously evaluated.
Agency Management
Other Government Agencies
Climate and culture
Community Members/Groups
Leadership
Scanning: Identifying and prioritizing
problems
Analysis: Analyzing problems
Non-Profits/Service Providers
Labor relations
Response: Responding to problems
Private Businesses
Decision-making
Media
Strategic planning
Assessment: Assessing problem-solving
initiatives
Policies
Organizational evaluations
Transparency
Organizational Structure
Geographic assignment of officers
Despecialization
Resources and finances
Personnel
Recruitment, hiring and selection
Personnel supervision/evaluations
Training
Information Systems (Technology)
Communication/access to data
Quality and accuracy of data
Using the Crime Triangle to focus on
immediate conditions (Victim/
Offender/Location)
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Standard Application Forms
Proposed Community Policing Plan
COPS grants must be used to initiate or enhance community policing activities, either directly by your law
enforcement agency, or (for non-law enforcement applicants) in collaboration with law enforcement. Please complete
the following questions to describe the types of community policing activities that you are currently engaged in and
that will result from COPS funding. For each question, answer on behalf of the applicant law enforcement agency, or
for non-law enforcement applicants, the law enforcement agency with whom you will collaborate.
You may find more detailed information about community policing at the COPS Office website
http://www.cops.usdoj.gov/Default.asp?Item=36.
Community Partnerships
Community partnerships are ongoing collaborative relationships between law enforcement and the individuals and
organizations they serve to both develop solutions to problems and increase trust in the police.
My Agency:
P1) Regularly distributes relevant crime and disorder information to community members.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
P2) Routinely seeks input from the community to identify and prioritize neighborhood problems (e.g., through
regularly scheduled community meetings, annual community surveys, etc.).
a
)
YES
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YES
YES
NO
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usegrant
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implementthis
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activity?
YES
NO
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Standard Application Forms
P3) Regularly collaborates with local government agencies that deliver public services.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
P4) Regularly collaborates with non-profit organizations and/or community groups.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
P5) Regularly collaborates with local businesses.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
P6) Regularly collaborates with informal neighborhood groups and resident associations.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
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P7) Regularly collaborates with federal government agencies through formal partnerships (e.g., taskforces,
working groups, etc.).
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
Problem Solving
Problem solving is an analytical process for systematically (1) identifying and prioritizing problems, (2) analyzing
problems, (3) responding to problems, and (4) evaluating problem-solving initiatives. Problem solving involves an
agency-wide commitment to go beyond traditional police responses to crime to proactively address a multitude of
problems that adversely affect quality of life.
My Agency:
PS1) Routinely incorporates problem-solving principles into patrol work.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
PS2) Identifies and prioritizes crime and disorder problems through the routine examination of patterns and
trends involving repeat victims, offenders, and locations.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
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Standard Application Forms
PS3) Routinely explores the underlying factors and conditions that contribute to crime and disorder problems.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
PS4) Systematically tailors responses to crime and disorder problems to address their underlying conditions.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
PS5) Regularly conducts assessments to determine the effectiveness of responses to crime and disorder
problems.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
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Organizational Transformation
Organizational transformation is the alignment of organizational management, structure, personnel and information
systems to support community partnerships and proactive problem-solving efforts.
My Agency:
OT1) Incorporates community policing principles into the agency’s mission statement and strategic plan.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
OT2) Practices community policing as an agency-wide efforti nvolving all staff (i.e., not solely housed in a
specialized unit).
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
OT3) Incorporates problem-solving and partnership activities into personnel performance evaluations.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
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Technology
Technology provides agencies with the tools to communicate more effectively externally with the public and internally
with their own staff, and the ability to understand and analyze community problems.
My Agency:
TEC01) Ensures that agency staff have appropriate access to relevant data (e.g., calls for service, incident and
arrest data, etc.).
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
TEC02) Uses technology (e.g., crime mapping or statistical software) to analyze and understand problems in
the community.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
TEC03) Uses technology (e.g., GIS/GPS for deployment or laptops for field reporting) to improve the agency’s
overall efficiency and effectiveness.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
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TEC04) Provides officers with necessary equipment to better prevent and/or respond to crime and disorder
problems.
a)
YES
If yes, do you plan to use grant funding to enhance or expand this activity?
YES
NO
b)
NO
If no, do you plan to use grant funding to initiate or implement this activity?
YES
NO
Community Policing Plan Narrative
Please describe your agency’s implementation plan for this program (if awarded), with specific reference to each of the
following elements of community policing: (a) community partnerships and support, including consultation with
community groups, private agencies, and/or other public agencies; (b) related governmental and community initiatives
that complement your agency’s proposed use of COPS funding; and (c) organizational transformation – how your
agency will use these funds, if awarded, to reorient its mission to community policing or enhance its involvement in
and commitment to community policing.
In the space provided, please address your agency’s implementation plan for this program with specific reference to
each of the following elements of community policing:
(a) Community partnerships and support, including consultation with community groups, private agencies,
and/or other public agencies.
[Responses are limited to a maximum of 5,000 characters.]
(b) Related governmental and community initiatives that complement your agency’s proposed use of COPS
funding.
[Responses are limited to a maximum of 5,000 characters.]
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(c) Organizational transformation – how your agency will use these funds, if awarded, to reorient its mission
to community policing or enhance its involvement in and commitment to community policing.
[Responses are limited to a maximum of 5,000 characters.]
CP1) To what extent is there community support in your jurisdiction for implementing the proposed grant
activities?
a) High level of support
b) Moderate support
c) Minimal support
CP2) If awarded, to what extent will the grant activities impact the other components of the criminal justice
system in your jurisdiction?
a) Potentially decreased burden
b) No change in burden
c) Potentially increased burden
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SECTION 6B: LAW ENFORCEMENT & COMMUNITY POLICING STRATEGY
CHP Applicants Only
Community Policing Strategy
COPS Office grants must be used to reorient the mission and activities of law enforcement agencies through initiating
community policing or enhancing their involvement in community policing. If awarded funds, your responses to
sections II(a) and II(b) that follow will constitute your agency’s community policing plan under this grant. Your
organization may be audited or monitored to ensure that it is initiating or enhancing community policing in accordance
with this plan. The COPS Office may also use this information to understand the needs of the field, and potentially
provide for training, technical assistance, problem solving and community policing implementation tools. Please note
that the COPS Office recognizes that your COPS-funded officer(s) (or an equal number of veteran officers who are
redeployed after hiring the entry-level COPS-funded officers) will engage in a variety of community policing activities
and strategies, including participating in some or all aspects of your identified community policing plan. Your
community-policing plan may be influenced and impacted by others within and outside of your organization; this is
considered beneficial to your community policing efforts.
At any time during your grant, you should be prepared to demonstrate (1) the community policing activities engaged in
prior to the grant award that are detailed in section I of this application and (2) how the grant funds were specifically
used to enhance (increase) or initiate community policing activities according to your community policing plan
contained in sections II(a) and II(b) of this application.
Finally, we also understand that your community policing needs may change during the life of your grant. Minor
changes to this plan may be made without prior approval of the COPS Office; however, grantees will be
required to report on progress and/or changes to the community policing plan (if any) through required
progress reports. If your agency’s community policing plan changes significantly, you must submit those changes to
the COPS Office for approval. Changes are “significant” if they deviate from the specific crime problems(s) originally
indentified and approved in the community policing plan submitted with the application. In some cases, changes to the
approved community policing strategies may also be deemed significant and may require approval of a modified
community policing plan by the COPS Office, depending on the scope and nature of those changes as identified in the
quarterly progress reports.
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Community Policing Definition Framework
The following is the COPS Office definition of community policing that emphasizes the primary components of
community partnerships, organizational transformation, and problem solving. Please refer to the COPS Office website
(www.cops.usdoj.gov) for further information regarding this definition.
Community policing is a philosophy that promotes organizational strategies, which support the systematic use of
partnerships and problem-solving techniques, to proactively address the immediate conditions that give rise to public
safety issues, such as crime, social disorder, and fear of crime.
The COPS Office has completed the development of a comprehensive community policing self-assessment tool for use
by law enforcement agencies. Based on this work, we have developed the following list of primary sub-elements of
community policing. Please refer to the COPS Office website (www.cops.usdoj.gov) for further information regarding
these sub-elements.
Community Partnerships:
Organizational Transformation:
Problem Solving:
Collaborative partnerships between the
law enforcement agency and the
individuals and organizations they serve
to both develop solutions to problems
and increase trust in police.
The alignment of organizational
management, structure, personnel and
information systems to support
community partnerships and proactive
problem-solving efforts.
The process of engaging in the proactive
ands ystematic examination of identified
problems to develop effective responses
that are rigorously evaluated.
Agency Management
Other Government Agencies
Community Members/Groups
Non-Profits/Service Providers
Private Businesses
Media
Climate and culture
Leadership
Labor relations
Decision-making
Strategic planning
Policies
Organizational evaluations
Transparency
Organizational Structure
Geographic assignment of officers
Despecialization
Resources and finances
Personnel
Recruitment, hiring and selection
Personnel supervision/evaluations
Training
Information Systems (Technology)
Communication/access to data
Quality and accuracy of data
Scanning: Identifying and prioritizing
problems
Analysis: Analyzing problems
Response: Responding to problems
Assessment: Assessing problem-solving
initiatives
Using the Crime Triangle to focus on
immediate conditions (Victim/Offender/
Location)
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I. Current Organizational Commitment to Community Policing
1) For each of the following statements, please answer in terms of existing agency policies and practices as they
relate to collaborative partnerships and problem solving activities (please check all that apply).
Activity
Community Partnerships
Problem Solving
Q1a. The agency mission statement, vision, and/or
goals includes references to:
Q1b. The agency strategic plan includes specific
goals and/or objectives relating to:
Q1c. The agency recruitment, selection and hiring
processes include elements relating to:
Q1d. Annual line officers valuations assess
performance in:
Q1e. Supervisor and manager evaluations assess
performance in:
Q1f. Line officers receive regular (at least once
every two years) training in:
2) Which of the following internal management practices does your agency currently employ?
Assignment of officers to specific neighborhoods or areas for longer periods of time to enhance customer service and facilitate
more contact between police and citizens
In-service training for officers on basic and advanced community policing principles
Defined community policing roles and expectations for officers
Early Intervention Systems that help identify officers who may be showing signs of stress, personal problem, and questionable
work conduct
Alternatives to formal disciplinary practices that encourage ethical behavior
Police officers ethical conduct initiative
Use of a departmental values statement to establish officer standards of behavior and guide disciplinary processes
None of the above
3) Which of the following do you count/measure to annually assess your agency’s overall performance (please
check all that apply):
Response times
Reported crimes
Reported incidents
Arrests and citations
Problem solving outcomes
Department employee satisfaction
Clearance rates
Complaints of officer behavior
Repeat calls for service
Social disorder/nuisance problems (e.g. graffiti, panhandling, loitering, etc.)
Satisfaction with police services
Fear of crime
Victimization (i.e. non-reported crime)
Community meetings held/attended
Use of force incidents
Meeting the priorities as identified in your agency strategic plan
My agency does not conduct annual assessments of overall performance
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4) Through which of the following does your agency routinely share information with community members (please
check all that apply):
Neighborhood, beat, and/or school meetings
Local media outlets
Agency newsletter
Neighborhood newsletters
Agency website
Social networking (Blogs, Twitterfeeds, Facebook pages, etc.)
Citizen alert system (telephone, email, text, etc.)
Public access television/radio
Community organization board membership
Public forums with Chief/Sheriff/Command staff
Posters, billboards, flyers
None of the above
5) Through which of the following ways does your agency routinely participate in collaborative efforts with federal,
tribal, state, and/or local law enforcement agencies:
NCIC/CJIS
Co-located staff or detail assignments, independent of task forces
Database systems that facilitate data and information sharing
Interoperable communication systems
Federally initiated task forces (e.g. HIDTA’s, Fusion centers, JTTF’s, etc.)
Other multi-agency task forces
None of the above
6) Through which of the following ways does your agency formally involve community members in influencing
agency practices and operations (please check all that apply):
Citizen police academies
Volunteer activities
Auxiliary police programs
Civilian review boards (e.g. disciplinary review boards)
Citizen advisory groups (i.e. informal advisory function)
Involvement in hiring decisions (i.e. interview panels, selection boards, etc.)
Involvement in contributing to annual line officer performance reviews
Representation on promotional boards
Participation in accountability and performance reporting and tracking meetings
Participation in complaint resolution process (i.e. formal mediation, disciplinary boards, etc.)
None of the above
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II(a) Proposed Community Policing Plan: Problem Solving and Partnerships
COPS grants must be used to initiate or enhance community policing activities. In this section you will be asked to
identify the crime and disorder problem and the partners to be engaged through your requested COPS funding.
Identifying the specific problem and partnerships that your agency plans to focus on is important to ensure that you
satisfy the requirements for COPS funding under this program and to ensure that ultimately the use of these funds will
initiate or enhance your agency’s capacity to implement community policing strategies.
7) Using the following list, select a problem that will be addressed with these grant funds. Please choose the option
that best fits your problem. You may select up to one problem to address through this grant funding.
When identifying a problem, it is important to think about the nature of similar incidents that taken together
comprise the problem, and accordingly describe it in precise, specific terms (e.g. “burglary of retail
establishments”, rather than just “burglary”). In doing this, it can be helpful to consider all aspects of the problem,
including the likely offenders, the suitable targets/victims, and how these come together in time and space.
Violent Crime Problems
Assault
Please specify your assault problem; for example, assaults in and around bars, gang violence, etc.
Homicide
Please specify your homicide problem; for example, gun homicide by serious previous offenders, gang related
homicide, domestic homicides, etc.
Rape
Please specify your rape problem; for example, acquaintance rape, rape in college dorm rooms, child or domestic
rape,etc.
Robbery
Please specify your robbery problem; for example, robbery of convenience stores, robbery of taxi drivers, bank
robbery, etc.
Domestic/Family Violence
Please specify your domestic/family violence problem; for example, domestic violence, stalking, child abuse,
elder abuse, etc.
Other Violent Crime Problem (please specify)
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Non-Violent Crime Problems
Burglary
Please specify your burglary problem; for example, burglary of single family houses, burglary of retail
establishments, burglary of construction sites etc.
Fraud
Please specify your fraud problem; for example, check fraud, identity theft, credit card fraud, fraud of the elderly,
etc.
Larceny/Theft (Non-Motor Vehicle)
Please specify your larceny/theft problem; for example, shoplifting, pick pocketing, etc.
Motor Vehicle Theft/Theft from Motor Vehicle
Please specify your motor vehicle theft problem/theft from motor vehicle; for example, organized motor vehicle
theft, joy riding, theft of motor vehicles from parking garages, theft from motor vehicle in targeted area, etc.
Vandalism
Please specify your vandalism problem; for example, graffiti, vandalism of public parks, tagging, etc.
Social Disorder
Please specify your disorder problem; for example, disorder in public places, disorder at day laborer sites,
disorder on school grounds etc.
Quality of Life Problem
Please specify your quality of life problem; for example, abandoned vehicles, pan handling, fear of crime, vacant
properties etc.
Prostitution
Please specify your prostitution problem; for example, street prostitution, organized prostitution, etc.
Other Non-Violent Crime Problem (please specify)
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Drug Related Problems
Drug Manufacturing/Trafficking
Please specify your drug manufacturing/trafficking problem; for example, clandestine methamphetamine labs,
drug trafficking across international borders, marijuana growing operations etc.
Drug Dealing
Please specify your drug dealing problem; for example, drug dealing in open air markets, drug dealing in
apartment complexes, gang related drug dealing
Drug Abuse
Please specify your drug abuse problem; for example, underage drinking, prescription drug abuse, drug abuse by
prostitutes etc.
Other Drug Related Problem (please specify)
Traffic/Pedestrian Safety Problems
Traffic Congestion
Please specify your traffic congestion problem; for example, traffic congestion around schools, traffic congestion
due to special events, traffic congestion during peak hours etc.
Pedestrian Safety
Please specify your pedestrian safety problem; for example, pedestrian safety during night time hours, pedestrian
safety around schools, pedestrian safety at crosswalks, pedestrian traffic on roadways, etc.
Driver Safety
Please specify your driver safety problem; for example, driving under the influence, speeding in residential areas,
street racing, distracted driving etc.
Traffic Accidents
Please specify your traffic accident problem; for example, traffic accidents by commercial drivers, traffic
accidents in residential areas, traffic accidents by young drivers etc.
Other Traffic/Pedestrian Safety Problem (please specify)
Police Operations and Specific Environment Problems
Inefficient Use of Police Resources
Please specify your inefficient use of police resources problem; for example, false burglar alarms, misuse of 911,
false bomb threats, etc.
Officer Ethics and Integrity
Please specify your officer ethics and integrity problem; for example, racial profiling, use of force, officer
misconduct, etc.
Police Response to Specific Populations
Please specify your police response to working with specific population problems; for example, building trust
with new immigrant communities, addressing the needs of persons with mental illness, the elderly, transients, or
ex-offenders, etc.
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Police Operations in Specific Environments
Please specify the specific environment problem; for example, crime on a campus, in an agricultural community,
in a park, etc.
Other Police Operations or Specific Environment Problem (please specify)
Child and Youth Safety Problems
Child Sexual Predators and Internet Safety
Please specify your child sexual predator problem; for example, non-compliant sexual offenders, trafficking in
children, child sexual abuse offenses, cyber-related crimes, etc.
School Based Policing
Please specify your school based policing problem; for example, crime in and around schools, bullying, truancy,
disorder on school grounds, theft of school property, etc.
Children Exposed to Violence
Please specify your children exposed to violence problem; for example, children’s reactions to domestic violence;
witnessing school violence; exposure to catastrophic events; etc.
Teen Violence
Please specify your teen violence problem; for example, teen gang activity, assaults among youth, teen date rape,
etc.
Other Child and Youth Safety Problem (please specify)
Homeland Security Problems
Protecting
ProtectingCritical
CriticalInfrastructure
InfrastructureProblems
Problems
Please specify your critical infrastructure problem; for example, addressing threats against facilities, developing
and testing incident response plans, etc.
Information or Intelligence Problems
Please specify your information and/or intelligence problem; for example, the need for criminal intelligence
capacity, engaging in information sharing, expanding utilization of fusion centers, etc.
Other Homeland Security Problem (please specify)
Please answer questions 7a thru 12 for each problem identified
7a) Briefly describe the problem that you will address with these grant funds [2,000
characters
and your
approachortoless]
the
problem. [4,000 characters or less]
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8) Which of the following information sources did you use to prioritize this problem as a problem to address
through this grant program (please check all that apply):
Police department data (e.g. police reports, calls for service, crime data, citizen complaints)
Agency personnel (e.g. officer feedback, command staff priorities)
Other local non law enforcement government agency data
Community based organizations (e.g. faith based, non-profits, social service providers)
Local businesses
Individual community members/community meetings
Community survey
Local government officials
The media
None of the above
9) If awarded funds, my agency will improve our understanding of this problem by examining (please check all
that apply):
Routinely collected law enforcement data/information related to the problem (e.g. arrest, incident reports, calls for service)
The location and/or time aspects of the problem (e.g. mapping)
The conditions and environmental factors related to the problem
The strengths and limitations of current responses to the problem
Non-law enforcement data/information related to the problem (e.g. insurance crash data, other government agency data, census
data, survey data)
Existing research and best practices related to the problem
Data/information from the community related to the problem (e.g. resident associations, business groups, non-profit
community service organizations)
Information about offenders contributing to the problem (e.g. offender interviews, arrest records)
Information about victims affected by the problem (e.g. crime reports, victim interviews)
Strengths and weaknesses of previous responses to the problem
None of the above
10) An important part of a comprehensive community policing plan is the formation of partnerships, such as working
with other public agencies, private organizations, or participation in regional law enforcement partnerships. If
awarded funds, will your agency initiate or enhance a partnership with an external group/organization to develop
responses to this problem?
Yes
No
[If Yes go to 10a, If No go to 11]
10a) If awarded funds, how many external groups/organizations will your agency initiate or enhance a
partnership with to develop responses to this problem
10b) Name the most important external groups/organizations that your agency will initiate or enhance a
partnership with to develop responses to this problem (maximum of three partners). Note: you may attach
optional letters of this support from any or all of these prospective partners in Section 13 of the application. You
will be limited to listing no more than three partners per public safety problem.
Partner 1
Partner 2
Partner 3
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[ASK FOR EACH PARTNER IDENTIFIED]
10c) For this partner, please indicate the statement that best characterizes this partner:
Local government agencies (non-law enforcement, e.g. probation/parole, parks and recreation, code enforcement, etc.)
Community based organizations (e.g. faith based, community redevelopment groups, social service providers,
resident associations)
Businesses operating in the community
Tribal law enforcement agencies [if selected, question 10d will be asked]
Federal, state, or local law enforcement agencies (non-tribal) including through multi-jurisdictional/regional partnerships [if
selected, question 10d will be asked]
Local educational institutions (schools/colleges/universities)
Individual stake holders (persons residing, working, or with an interest in the community or problem)
10d) For your Federal, state, local, or Tribal law enforcement agency partner, please identify what steps you and
your partner have taken or plan to take to formalize your commitment to addressing this problem(please check all
that apply):
formalized MOU/MOA signed by both partners which governs partnership activities, roles, and responsibilities
established shared ownership and responsibility
co-committed resources (financial, staffing, etc.)
established processes and/or systems to share relevant data
conduct routine meetings at the operational or strategic level to plan and implement responses
conduct joint training and planning exercises
None of the above
11) If awarded funds my agency will use the following information sources to assess our response to this problem to
determine whether the response was implemented and achieved the desired outcomes (please check all that apply):
Routinely collected law enforcement data/information related to the problem (e.g. crime data, arrests, incident reports,
calls for service)
Data/information regarding whether the response was implemented as planned
Police data collected for this specific problem (e.g. problem-specific surveys, field interview contact cards, etc.)
Non-police data/information related to the problem (e.g. insurance crash data, other government agency data, census
data, survey data)
Data/information from the community related to the problem (e.g. resident associations, business groups,non-profit
community service organizations)
Information about offenders contributing to the problem (e.g. offender interviews, arrest records, probation/parole data)
Information about victims and/or stake holders affected by the problem (e.g. crime reports, victim interviews)
None of the above
12) To the best of your ability at this time, would you say your primary goal(s) in responding to <> include which of the following (please select up to 3):
Eliminating the problem
Reducing the number of incidents
Increasing public trust in your agency
Reducing the seriousness of the incidents or the amount of harm
Reducing the number of victims and/or repeat victims
Reducing the number of offenders and/or repeat offenders
Moving the problem to another area
Getting other agencies and/or stake holders to assume responsibility for the problem
Improving the response to the problem (i.e., more comprehensive and coordinated way of dealing with the problem,
providing better services to victims, or greater efficiency in dealing with the problem)
Improving citizen perceptions of the problem
Increasing the number of arrests/citations
Reducing the number of calls for service
None of the above
ORI#
Standard Application Forms
Questions are no longer problem specific, please answer the following questions once per respondent.
II(b) Proposed Community Policing Plan: Organizational Transformation
COPS grants must be used to initiate or enhance community policing activities. In this section you will be asked to
identify the organizational change(s) that your agency plans to focus on through your requested COPS funding.
Identifying the specific organizational change(s) that your agency plans to focus on is important to ensure that you
satisfy the requirements for COPS funding under this program, and to ensure that ultimately the use of these funds will
initiate or enhance your agency’s capacity to implement community policing strategies.
13) If awarded funds, will your agency initiate or enhance any of the following internal changes to personnel
management? (Select no more than 2 internal changes to personnel management that will be addressed with these
grant funds.)
Flexibility in officer shift assignments to facilitate addressing specific problems
Assignment of officers to specific neighborhoods or areas for longer periods of time to enhance customer service and
facilitate more contact between police and citizens
Recruitment and hiring practices that reflect an orientation towards problem solving and community engagement
In-service training for officers on basic and advanced community policing principles
Field training officer (FTO) programs that teach and test problem solving, community engagement, and critical thinking
skills
Further define and clarify community policing roles and expectations for officers
Personnel evaluation systems that assess officer activities, accomplishments, and performance related to problem solving
and community engagement
Early intervention systems that help identify officers who may be showing early signs of stress, personal problems, and
questionable work conduct
First-line supervisory skills to support officer problem solving and community engagement activities
Career development and/or promotional processes that reinforce problem solving and community engagement
None of the above
13a) Briefly describe each specific internal personnel management change or enhancement that you identified
above that you will address with these grant funds. [2,000 characters or less]
Please provide a narrative for each internal change to personnel management identified.
14) If awarded funds, will your agency initiate or enhance any of the following internal changes to agency
management? (Select up to 2 internal changes to agency management that will be addressed with these grant funds.)
Agency mission statement, vision, and/or goals that reflect the core values of community policing
Agency strategic plan that outlines the goals and objectives around community policing and other departmental priorities
Organizational performance measurement systems that include community policing metrics, and conduct annual
assessments of agency performance
Police officer ethical conduct initiative (e.g. procedural justice, values-based policing, etc.)
Technology systems that provide officers, analysts, and the community better and more timely access to data and
information
Mediation strategies to resolve citizen complaints
Collection, analysis, and use of crime data and information in support of problem solving goals
Formal accreditation process
System to capture and track problem solving and partnership efforts and activities
An organizational assessment of community policing
Level and frequency of communication with the community on crime problems and agency activities to enhance
transparency
None of the above
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14a) Briefly describe each internal agency management change or enhancement that you identified above that
you will address with these grant funds [2,000 characters or less]
Please provide a narrative for each internal change to agency management identified.
III. General Community Support and Engagement
15) Did your agency consult with any of the following groups/organizations on the development of this community
policing plan? (please check all that apply)
Local government agencies (non-law enforcement, e.g. probation/parole, parks and recreation, code enforcement, etc.)
Community based organizations (e.g. faith based, community redevelopment groups, social service providers, resident
associations)
Businesses operating in the community
Tribal law enforcement agencies (outside your jurisdiction)
Other Federal, state, or local law enforcement agencies
Multi-jurisdictional or regional task forces/partnerships
Local educational institutions (schools/colleges/universities)
Local government officials
Individual stakeholders residing, working or with an interest in the community and/or problem
None of the above
16) To what extent are there related governmental and/or community initiatives that complement your agency’s
proposed community policing plan?
a) There are a significant number of related initiatives
b) There are a moderate number of related initiatives
c) There are a minimal number of related initiatives
d) There are no related initiatives
17) To what extent is there community support in your jurisdiction for implementing the proposed community
policing plan?
a) High level of support
b) Moderate level of support
c) Minimum level of support
18) If awarded funds, to what extent will the community policing plan impact the other components of the criminal
justice system in your jurisdiction?
a) Potentially decreased burden
b) No change in burden
c) Potentially increased burden
ORI#
Standard Application Forms
SECTION 7: NEED FOR FEDERAL ASSISTANCE
A. Service Population
1. Enter the total population of the government entity applying for this grant using the latest census estimate available
in the American Fact Finder at http://FactFinder.census.gov.
2. Check here if the population of the entity applying for this grant is not represented by U.S. Census figures (e.g.,
[If checked, complete 2a – 2b.]
colleges, special agencies, school police departments, etc.).
2a. If the population of the entity applying for this grant is not represented by U.S. Census figures, please indicate the
size of the population as of the latest available estimate:
2b. Please indicate the source of this population estimate:
(e.g., website address)
3. What is the actual population your department serves as the primary law enforcement entity?
This may or may not be the same as the population specified above. For example, a service population may be the
census population minus incorporated towns and cities that have their own police department within your geographic
boundaries or estimates of ridership (e.g., transit police) or visitors (e.g., park police). An agency with primary law
enforcement authority is defined as having first responder responsibility to calls for service for all types of criminal
incidents within its jurisdiction.
3a. If applicable, please explain why the service population differs from the census population:
B. Explanation of Need for Federal Assistance
All applicants are required to explain their inability to address the need for this award without federal assistance. Please
do so in the space below.
[Please limit your responses to a maximum of 3,000 characters.]
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Standard Application Forms
C. Fiscal Health
Note: If your application involves a contract for law enforcement services please refer to the instructions regarding contracting arrangements
found in Section 7: Fiscal Health of the Application Guide before completing this section.
1) Enter your law enforcement agency’s total operating budget for the current AND previous two fiscal years.
Please note: All figures must be rounded to the nearest whole dollar.
CURRENT FISCAL YEAR (<>) $
PREVIOUS FISCAL YEAR (<>) $
PREVIOUS FISCAL YEAR (<>) $
2) Enter the total jurisdictional (city, county, state, tribal, university) locally-generated revenues for the current
AND previous two fiscal years. Locally-generated revenues may include locally-generated property taxes, sales taxes,
and other taxes and revenue sources (e.g., transportation taxes, transient lodging taxes, licensing fees, other nonproperty taxes, and franchise taxes). For example, college/university police departments would include tuition and fees,
park police may include entrance and parking fees, etc. Please note: All figures must be rounded to the nearest whole
dollar.
CURRENT FISCAL YEAR (<>) $
PREVIOUS FISCAL YEAR (<>) $
PREVIOUS FISCAL YEAR (<>) $
3) Since <>, what percentages of the following employees in your jurisdiction (city, county, state,
tribal, university) have been reduced through lay-offs?
Civilian Law Enforcement Agency Personnel
%
Sworn Law Enforcement Agency Personnel
Other Government Agency Personnel
%
%
4) Since <>, what percentages of the following employees in your jurisdiction (city, county, state,
tribal, university) have been reduced through furloughs that have lasted or are scheduled to last a minimum of forty
hours per affected employee over the course of a fiscal year?
Civilian Law Enforcement Agency Personnel
Sworn Law Enforcement Agency Personnel
Other Government Agency Personnel
%
%
%
5) Since <>, what percentages of the following authorized positions in your jurisdiction (city, county,
state, tribal, university) are currently unfilled due to official policies and/or decisions that limit your jurisdiction’s
ability to fill vacancies (i.e., hiring freezes)? For example, if your agency has ten authorized sworn positions and one is
currently frozen, you would enter 10% on the sworn personnel line.
Civilian Law Enforcement Agency Personnel
Sworn Law Enforcement Agency Personnel
Other Government Agency Personnel
%
%
%
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Standard Application Forms
6) The U.S. Census Bureau American Community Survey (ACS) provides multi-year poverty rate estimates for
communities. Please go to the U.S. Census Bureau’s American FactFinder (http://FactFinder.census.gov) to
determine the percentage of families in poverty in your jurisdiction based on the 2005 - 2009 ACS. For
jurisdictions not included in the census (e.g., schools, universities, transit, parks), please check the box for “Not
Applicable.” Please see the program Application Guide for additional information and help in using the American
FactFinder. Please note: All figures must be rounded to the nearest whole percent.
Percentage of families in poverty
%
Not Applicable
7) The Bureau of Labor Statistics’ Local Area Unemployment Statistics (LAUS) program provides monthly
estimates of unemployment for communities. Please go to the Bureau of Labor Statistics’ LAUS website
(www.bls.gov/lau/data.htm) to find detailed instructions for looking up your local area’s unemployment rate. It
may be necessary to select the nearest best match to your jurisdiction (for example, a city of fewer than 25,000 people
may report their county level rate). Please see the program Application Guide for additional information and help in
using the LAUS data. For jurisdictions not included in the census (e.g., schools, universities, transit, parks), please
check the box for “Not Applicable.” Please note: All figures must be rounded to the nearest whole percent.
Percentage unemployed for December 2011
%
Not Applicable
8) Indicate your jurisdiction's estimated residential property foreclosure rate for calendar year <>. This
rate should be calculated as the total number of new default and auction foreclosure filings and/or new Real-Estate/
bank-owned foreclosures (REOs) in <> divided by the total number of residential households.
Bank Owned
%
Check here if the information necessary to calculate this rate is unavailable
9) Indicate if your jurisdiction has experienced any of the following events since <>:
(Check all that apply)
A declaration of natural or other major disaster or emergency has been made pursuant to the Robert T. Stafford Disaster
Relief and Emergency Assistance Act. (42 U.S.C. 5121 et seq.)
A declaration as an economically or financially distressed area by the state in which the applicant is located.
Downgrading of the applicant’s bond rating by a major rating agency.
Has filed for or been declared bankrupt by a court of law.
Has been placed in receivership or its functional equivalent by the state or federal government.
Taken on additional law enforcement duties and responsibilities resulting from an agency merger or the disbanding of a
neighboring law enforcement agency (which did not result in a new or supplemented funded contract to provide these law
enforcement services)
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Standard Application Forms
D. Property/Violent Crime
1) Using UCR crime definitions, enter the actual number of incidents reported to your agency in the previous
three calendar years <> for the following crime types. Note that only those incidents for which
your agency had primary response authority should be provided.
UCR Data *
<>
<>
<>
Criminal Homicide
Forcible Rape
Robbery
Aggravated Assault
Burglary
Larceny (except motor vehicle theft)
Motor Vehicle Theft
Please note: Only those incidents for which your agency had primary response authority should be provided. An agency with primary response authority is
defined as the first responder to calls for service for all types of criminal incidents within its jurisdiction. Agencies are not considered to have primary response
authority if they only: respond to or investigate a specific type(s) of crime(s); respond to or investigate crimes within a correctional facility; serve warrants;
provide courthouse security; transport prisoners; and/or have cases referred to them for investigation or investigational support.
*Note: If your agency currently reports to NIBRS, or does not report crime incident totals at all, please ensure that your data is converted to UCR Summary
Data style. Please see the COPS Application Guide or the FBI’s UCR Handbook (www.fbi.gov/ucr/handbook/ucrhandbook04.pdf) for more information.
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Standard Application Forms
SECTION 8: CONTINUATION OF PROJECT AFTER FEDERAL FUNDING ENDS
If you are applying for a COPS grant with a post-award retention requirement, please complete A. If you are
applying for a COPS grant without a post-award retention requirement, please complete B.
A. Continuation of Project after Federal Funding Ends (for COPS grants with a retention
plan requirement)
Applicants must plan to retain all sworn officer positions awarded under your COPS hiring grant for a minimum of
12 months at the conclusion of 36 months of federal funding for each position. The retained COPS funded positions
should be added to your agency’ law enforcement budget with state and/or local funds at the end of grant funding,
over and above the number of locally-funded sworn officer positions that would have existed in the absence of the
grant. These additional position(s) must be retained using state, local, or other non-federal funding only. You may
not use funds awarded by other federal grants to cover the costs of retention. At the time of updated grant
application, applicants must affirm that they plan to retain the positions and identify the planned source(s) of
retention funding. We understand that your agency’ source(s) of retention funding may change during the life of the
grant. Your agency should maintain proper documentation of any changes in the event of an audit, monitoring or
other evaluation of your grant compliance. Please refer to the frequently asked questions on retention which can be
found here http://www.cops.usdoj.gov/Default.asp?Item=2364.
1. Will your agency plan to retain any additional positions awarded under this grant for a minimum of 12
months at the conclusion of federal funding for each position?
YES
NO
Note: Agencies that do not plan to retain all the positions awarded under this grant are ineligible to receive CHP funding
2. Please identify the source(s) of funding that your agency plans to utilize to cover the costs of retention:
(check all that apply)
General funds
Raise bond/tax issue
Private sources/donations
Non-federal asset forfeiture funds (subject to approval from the state or local oversight agency)
Fundraising efforts
State, local, or other non-federal grant funding
Other (Please provide a brief description of the source(s) of funding not to exceed 350 characters.)
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Standard Application Forms
B. Continuation of Project after Federal Funding Ends (for other COPS grants with no
retention plan requirement)
Please complete these questions to indicate any plans you may have to continue this program, project, or activity after
the conclusion of federal funding.
1. Does your agency plan to obtain necessary support and continue the program, project, or activity
following the conclusion of federal support?
YES
NO
2. Please identify the source(s) of funding that your agency plans to utilize to continue the program, project,
or activity following the conclusion of federal support: (check all that apply)
General funds
Raise bond/tax issue
Private sources/donations
Non-federal asset forfeiture funds (subject to approval from the state or local oversight agency)
Fundraising efforts
State, local, or other non-federal grant funding
Other (Please provide a brief description of the source(s) of funding not to exceed 350 characters.)
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Standard Application Forms
SECTION 9: SCHOOL SAFETY ASSESSMENT
SOS Applicants Only
Agencies that have conducted a school safety assessment within the last three years must answer questions about the
assessment conducted. If your agency has not conducted a school safety assessment within the last three years, your
agency will be asked to complete one as a requirement for grant funding. Funding may be requested through this grant
application to conduct the school safety assessment. You will also be required to answer questions that will focus on
the assessment that will be conducted during the grant implementation period. Please note, your agency may request
other allowable items and is not limited to solely funding a school safety assessment.
Has your agency completed an assessment within the last three years?
Select One...
APPLICANTS WHICH HAVE CONDUCTED SCHOOL SAFETY ASSESSMENTS WITHIN THE LAST THREE YEARS (Questions 1-5)
1. When was the assessment completed?
2. Who conducted the assessment? Identify ALL internal and external parties involved.
Teachers
Students
Parents
Community Stakeholders
Local Business
School Security/Safety Personnel
Consultants
School Administrators
Other
3. Identify what aspects of school safety and security were assessed. Select all that apply:
Security and Surveillance Systems
Building Access Control
Classroom Security
Student and Teacher Handbooks
Emergency Communications
Safety and Security of School Grounds
School Code of Conduct
Crisis Plans
School Incident and Discipline Data
Evaluation of Site Access Control Systems
Indoor/Outdoor Athletic Facilities located on School Grounds
Other
4. Did the assessment include any staff, teacher, student, or parent survey data related to school climate?
Yes
Yes
No
If yes, please describe the survey instrument your agency used. Answers are limited to 1000 characters.
5. What were the findings of the assessment? Specifically outline the school based problems identified. Please
note: All budget items requested must be justified in your budget narrative as a result of these findings of
the assessment. Answers are limited to 2000 characters.
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Standard Application Forms
APPLICANTS WHICH HAVE NOT CONDUCTED SCHOOL SAFETY ASSESSMENTS WITHIN THE LAST THREE YEARS (Questions 6-11)
6. When do you plan to complete the assessment?
The School Safety Assessment MUST be conducted within the grant implementation period.
7. Will your agency request funding through this grant application to conduct a school safety assessment?
Yes
No
If your agency answered no, please explain your response. Answers are limited to 1000 characters.
8. Who do you plan to include in your assessment? Identify ALL internal and external parties that may be
involved. Select all that apply:
Teachers
Students
Parents
Community Stakeholders
Local Business
Law Enforcement/ Safety Personnel
Consultants
School Administrators
Other
9. Identify what aspects of preventing school violence that you intend to assess. Select all that apply:
Security and Surveillance Systems
Building Access Control
Classroom Security
Student and Teacher Handbook
Emergency Communications
Safety and Security of School Grounds
School Code of Conduct
Crisis Plans
School Incident and Discipline Data
Evaluation of Site Access Control Systems
Indoor/Outdoor Athletic Facilities located on School Grounds
Other
10. Does your agency plan to include any staff, teacher, student, or parent survey data related to school climate?
Yes
No
If yes, please describe the survey instrument your agency plans to use. Answers are limited to 1000 characters.
11. Specifically identify any preliminary results of the school based problems and the source of the findings.
Answers are limited to 2000 characters.
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Standard Application Forms
SECTION 10: EXECUTIVE SUMMARY
Please provide a brief summary of how your agency will use this federal funding. Refer to the COPS Application
Guide for clarification on specific information to include in your summary, and be sure to provide a description of how
you expect this grant to impact public safety and/or crime prevention in your community. The Executive Summary
may be used to keep Congress or other executive branch agencies informed on law enforcement strategies to deter
crime in your community.
[Responses are limited to a maximum of 3,000 characters.]
SECTION 11: PROJECT DESCRIPTION (NARRATIVE)
Please include in your application an in-depth narrative response detailing your proposed project. Please refer to the
COPS Application Guide: "How to Apply" for information on what should be included in your response, as well as any
additional formatting requirements and page length limitations. Note: Community Policing Development (CPD)
grant applicants must submit their entire project description as an attachment in Section 13 of this application.
A. Problem Identification
[Responses are limited to a maximum of 3,000 characters.]
B. Project Goals/Objectives
[Responses are limited to a maximum of 3,000 characters.]
C. Building Relationships and Solving Problems
[Responses are limited to a maximum of 3,000 characters.]
D. Implementation Plan
[Responses are limited to a maximum of 3,000 characters.]
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E. Evaluation Plan/Effectiveness of Program
Standard Application Forms
[Responses are limited to a maximum of 3,000 characters.]
F. Project Description (Narrative) Attachment:
Community Policing Development (CPD) applicants must submit their entire project description as an attachment in
Section 13 of this application.
Standard Application Forms
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SECTION 12: OFFICIAL PARTNER(S) CONTACT INFORMATION
An official "partner" under the grant may be a governmental, private, school district, or other applicable entity that has
established a legal, contractual, or other agreement with the applicant for the purpose of supporting and working
together for mutual benefits of the grant. Please see the COPS Application Guide for more information on official
partners that may be required.
Title:
First Name:
MI:
Last Name:
Suffix:
Name of Partner Agency (e.g., Smithville High School):
Type of Partner Agency (e.g., School District):
Street Address 1:
Street Address 2:
City:
State:
Telephone:
Zip Code:
Fax:
E-mail:
Click here to add additional partners.
Person Submitting this Application
By clicking this box and typing my name below, I certify that I have been legally and officially authorized by the
appropriate governing body to identify the partner(s) listed above and act on behalf of the grant applicant entity. I
also certify that the above agency (or agencies) is a partner (or are partners) to the grant project as required by the
grant and that our agencies mutually agreed to this partnership as related to this grant project prior to submission
of this grant application. In addition, I certify that the information provided above regarding the partner(s) is true
and accurate to the best of my knowledge. I understand that false statements or claims made in connection with
COPS programs may result in fines, imprisonment, debarment from participating in federal grants, cooperative
agreements, or contracts, and/or any other remedy available by law to the Federal Government.
Please type your name here in place of your signature:
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Standard Application Forms
SECTION 13: APPLICATION ATTACHMENTS
This section should be used to attach any required or applicable attachments to your grant application (e.g.,
Memorandum of Understanding, etc.).
If the program for which you are applying requires a Memorandum of Understanding (MOU), this document should
define the roles and responsibilities of the individuals and partner(s) involved in your proposed project. Please refer to
the program-specific Application Guide to determine if an MOU or other application attachments are required. The
Guide will also specify if optional attachments are permitted for submission.
ADD ATTACHMENTS
<< Uploaded Attachment 1 Name >>
Select One...
<< Uploaded Attachment 2 Name >>
Select One...
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Standard Application Forms
SECTION 14: BUDGET DETAIL WORKSHEETS
Instructions for Completing the Budget Detail Worksheets
The following Budget Detail Worksheets are designed to allow all COPS grant and cooperative agreement applicants
to use the same budget forms to request funding. Allowable and unallowable costs vary widely and depend upon the
type of COPS program. The maximum federal funds that can be requested and the federal/local share breakdown
requirements also vary.
Please refer to the program-specific Application Guide to determine the allowable/unallowable costs, the maximum
amount of federal funds that can be requested, and the federal/local share requirements for the COPS program for
which your agency is applying. To assist you, sample Budget Detail Worksheets are included in each Application
Guide.
Please complete each section of the Budget Detail Worksheets applicable to the program for which you are applying
(see the program-specific Application Guide for requirements). If you are not requesting anything under a particular
budget category, please check the appropriate box in that category indicating that no positions or items are requested.
All calculations should be rounded to the nearest whole dollar. Once the budget for your proposal has been completed,
a budget summary page will reflect the total amounts requested in each category, the total project costs, and the total
federal and local shares.
If you need assistance in completing the Budget Detail Worksheets, please call the COPS Office Response
Center at 800-421-6770.
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A. SWORN OFFICER POSITIONS
Standard Application Forms
No Sworn Officer Positions Requested
Instructions: This worksheet will assist your agency in reporting your agency’s current entry-level salary and benefits
and identifying the total salary and benefits request per officer position for the length of the grant term. Please list the
current entry-level base salary and fringe benefits rounded to the nearest whole dollar for one full-time sworn officer
position within your agency. Do not include employee contributions. (Please refer to the program-specific Application
Guide for information on the length of the grant term for the program under which you are applying.)
Special note regarding sworn officer fringe benefits: For agencies that do not include fringe benefits as part of the
base salary costs and typically calculate these separately, the allowable expenditures may be included under Part 1,
Section B. Any fringe benefits that are already included as part of the agency’s base salary (Part 1, Section A of the
Sworn Officer Budget Worksheet) should not also be included in the separate fringe listing (Part 1, Section B).
Please refer to the program-specific Application Guide for information about allowable and unallowable fringe
benefits for sworn officer positions requested under the program to which your agency is applying.
Standard Application Forms
$
$
Exempt:
6.2%
Exempt:
1.45%
$
$
$
Other Select One...
Benefits Sub-Total Per Year (1 Position)
C. Total Year Salary and Benefits (1 Position):
D. Total Salary and Benefits for Years 1, 2, and 3 (1 Position): $
$
$
Other Select One...
Fixed Rate:
Unemployment Insurance Exempt:
$
$
Fixed Rate:
Exempt:
Worker’s Compensation
$
Other Select One...
Fixed Rate:
Retirement
$
Number of Hours Annually:
Sick Leave
$
$
$
Fixed Rate:
Fixed Rate:
$
$
Number of Hours Annually:
Family:
Fixed Rate:
Fixed Rate:
%
%
%
%
%
%
%
%
%
%
%
%
% OF BASE
Year 1 Fringe Benefits
COST:
Vacation
Life Insurance
Individual:
Health Insurance
Cannot exceed 1.45% of Total Base Salary.
Medicare
Cannot exceed 6.2% of Total Base Salary.
Social Security
FRINGE BENEFITS:
$
$
$
$
$
$
$
$
$
$
$
$
$
$
X
COST:
# of Positions = $
%
%
%
%
%
%
%
%
%
%
%
%
% OF BASE
Year 2 Fringe Benefits
Year 2 Salary (As applicable)
Enter the second year base salary
for one entry-level sworn officer
position.
Year 1 Salary
Enter the current first year entrylevel base salary for one sworn
officer position.
B. Fringe benefit costs should be calculated for each year of the grant term.
A. Base Salary Information
$
$
$
$
$
$
$
$
$
$
$
$
$
$
COST:
$
%
%
%
%
%
%
%
%
%
%
%
%
% OF BASE
Year 3 Fringe Benefits
Year 3 Salary (As applicable)
Enter the third year base salary for
one entry-level sworn officer
position.
specific Application Guide, you may also be required to project Year 2 and Year 3 salaries. To learn more about what types of officer fringe benefit costs are allowable, please click here
A. Full-Time Entry-Level Sworn Officer Base Salary Information
No Sworn Officer Positions Requested
Part 1: Instructions: Please complete the questions below based on your agency’s entry-level salary and benefits package for one locally-funded officer position. As applicable per the program-
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Standard Application Forms
Part 2: Sworn Officer Salary Information
If your agency's second and/or third-year costs for salaries and/or fringe benefits increase after the first year,
check the reason(s) why in the space below:
Cost
Cost of
of living
living adjustment
adjustment (COLA)
(COLA)
Step
Step raises
raises
Change
Change in
in benefit
benefit costs
costs
Part 3: Federal/Local Share Costs (for Hiring Grants)
If the COPS Hiring Grant Program requires a local match, the grantees are required to pay a progressively
larger share of the cost of the grant with local funds over the grant period. Please refer to the program-specific
Application Guide to determine if this section is applicable. This means that your local match must increase each
year, while the federal share must decrease. Please project in the chart below how your agency plans to assume a
progressively larger share of the grant costs during each year of the program. The chart is a projection of your plans;
while your agency may deviate from these specific projections during the grant period, it must still ensure that the
federal share decreases and the local share increases.
Year 1
Year 2
Year 3
Federal Share
$
$
$
Local Share
$
$
$
Totals
$ (Pre-populated)
$ (Pre-populated)
Total salary and benefits for years 1, 2 & 3 (all positions):
$ (Pre-populated from budget)
Total federal share:
$ (Pre-populated from budget)
Total local share required (sworn officer costs):
(Based on Years 1, 2 & 3 costs for all sworn positions)
$ (Pre-populated from budget)
$ (Pre-populated)
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Standard Application Forms
Part 4: Waiver of Local Match
The COPS Office may grant a waiver of some or all of a grantee's local match requirement. An applicant that
is requesting a partial or full wavier of the local match requirement is stating that in the absence of this
additional federal assistance resulting from a reduction of the local match requirement, at this time the
applicant would be unable to implement the grant. During the application review process, your agency’ waiver
request will be evaluated based on a demonstration of significant fiscal need as supported by the fiscal health
data provided in this application and the specific amount of the waiver being requested. If the waiver request is
NOT supported by application data, your agency’ request for a waiver will be denied and your application will
be removed from consideration. The COPS Office’ ability to accommodate your request will be based on
demand, available funding, and the thresholds of financial need as established by the COPS Office. Therefore,
you should carefully determine the maximum local share your agency would be able to contribute if awarded.
Q1: Are you requesting a waiver of the local match based upon significant fiscal need? YES/NO
If applicant answers “NO”, they would continue with the application; if “YES”, the following question would
appear:
Q1a: If awarded, please indicate the maximum local share your agency would be able to contribute to the total
project cost in order to implement the grant. $_____ pre-populates with percentage_____%
Based on the waiver request above, your federal share would be ____ and your local share would be ____ if
your application was funded.
No Civilian/Non-Sworn Officer Positions Requested
Standard Application Forms
$
Exempt:
6.2%
Exempt:
1.45%
Indicate # of positions
%
$
$
$
Other Select One...
Benefits Sub-Total Per Year (1 Position)
Total (A+B)
Civilians/Non-Sworn Personnel Total $
If requesting additional positions with identical budget check here
D. Total Salary and Benefits for Years 1, 2, and 3 (1 Position): $
%
%
%
$
$
Other Select One...
Fixed Rate:
Exempt:
Unemployment Insurance
%
$
$
Fixed Rate:
Exempt:
Worker’s Compensation
%
$
%
%
%
%
%
%
Other Select One...
Fixed Rate:
Retirement
$
Number of Hours Annually:
Sick Leave
$
Fixed Rate:
$
$
Fixed Rate:
$
$
Number of Hours Annually:
Family:
Fixed Rate:
Fixed Rate:
% OF BASE
Year 1 Fringe Benefits
COST:
Vacation
Life Insurance
Health Insurance Individual:
Cannot exceed 1.45% of Total Base Salary.
Medicare
Cannot exceed 6.2% of Total Base Salary.
Social Security
FRINGE BENEFITS:
%
%
%
%
%
%
%
%
%
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
COST:
$
%
%
%
%
%
%
%
%
%
%
%
%
% OF BASE
Year 3 Fringe Benefits
If requesting other position(s) with different budget(s), check here
$
$
%
%
%
$
$
$
% OF BASE
Year 2 Fringe Benefits
COST:
$
x
% of time on project =
$
x
x
% of time on project =
$
% of time on project =
Year 3 Salary (As applicable)
Enter the third year base salary for
one civilian/non-sworn position.
Year 2 Salary (As applicable)
Enter the second year base salary
for one civilian/non-sworn position.
Year 1 Salary
Enter the current first year base
salary for one civilian/non-sworn
position.
$
B. Fringe benefit costs should be calculated for each year of the grant term.
(One position per worksheet)
Description
Position Title
A. Base Salary Information
Part 1: Instructions: Please complete the questions below for one non-sworn position salary and benefits package. As applicable per the program-specific Application Guide,
you may also be required to project Year 2 and Year 3 salaries.
B. Base Salary and Fringe Benefits for Civilian/Non-Sworn Personnel
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Standard Application Forms
C. EQUIPMENT/TECHNOLOGY
No Equipment/Technology Requested
Instructions: List non-expendable items that are to be purchased. Provide a specific description for each
item and explain how the item supports the project goals and objectives as outlined in your application.
Non-expendable equipment is tangible property (e.g., technology) having a useful life of more than one year
and an acquisition cost of $5,000 or more per unit. Expendable items should be included either in the
“SUPPLIES” or “OTHER” categories. Applicants should analyze the cost benefits of purchasing versus
leasing equipment, especially for high-price items and those subject to rapid technical advances. Rented or
leased equipment costs should be listed in the “CONTRACTS / CONSULTANTS” category.
Please be advised that, to the greatest extent practical, all equipment and products purchased with these funds
must be American-made.
For agencies purchasing items related to enhanced communications systems, the COPS Office expects
and encourages that, wherever feasible, such voice or data communications equipment should be
incorporated into an intra- or interjurisdictional strategy for communications interoperability among
federal, state, and local law enforcement agencies.
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more lines please check the available box. Please limit your descriptions to 1000 characters.
Item Name
Computation
Per Item Subtotal
Description
(# of Items/Units X Unit Cost)
More Equipment/Technology Entries
Required
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
Equipment/Technology Total: $
Standard Application Forms
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D. SUPPLIES
No Supplies Requested
Instructions: List items by type (office supplies; postage; training materials; copying paper; books; handheld tape recorders; etc). Provide a specific description for each item and explain how it supports the
project goals and objectives outlined in your application. Generally, supplies include any materials that
are expendable or consumed during the course of the project.
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more lines please check the available box. Please limit your descriptions to 1000 characters.
Computation
Item Name
(# of Items/Units X Unit Cost)
More Supply Entries Required
Per Item Subtotal
(
X
) $
(
X
) $
(
X
) $
(
X
) $
(
X
) $
(
X
) $
(
X
) $
(
X
) $
(
X
) $
(
X
) $
Supplies Total: $
Description
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E. TRAVEL/TRAINING
No Travel/Training Requested
Instructions: Itemize grant-related travel expenses of grantee personnel (excluding consultants, whose
expenses are listed in Section F) by event (e.g., mandatory training, staff to training, field interviews, advisory
group meetings). Identify the location of travel whenever possible, and show the number of staff expected to
attend each event. Training fees, transportation, lodging and per diem rates for trainees should be listed as
separate travel items. Grantee travel costs specific to the grant project may be based on the grantee's written
travel policy, assuming the costs are reasonable. Grantees without a written travel policy must follow the
established federal rates (found at www.gsa.gov) for lodging, meals, and per diem. For all grantees (with or
without a written travel policy), airfare travel costs must be one of the following: the lowest discount
commercial airfare, standard coach airfare, or the Federal Government contract airfare (if authorized and
available). Note: Any local training costs (within a 50-mile radius) should be listed under Section G ("Other
Costs").
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more lines please check the available box. Please limit your descriptions to 1000 characters.
Event Title and Location
Event Costs
Registration
Description
$
Transportation $
Lodging
$
Per diem
$
Registration
$
Transportation $
Lodging
$
Per diem
$
Registration
$
Transportation $
Lodging
$
Per diem
$
Registration
$
Transportation $
Lodging
$
Per diem
$
Registration
$
Transportation $
Lodging
$
Per diem
$
Registration
$
Transportation $
More Travel/Training Entries
Required
Number of Staff Per Event Subtotal
Lodging
$
Per diem
$
$
$
$
$
$
$
Travel/Training Total:
$
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Standard Application Forms
F. CONTRACTS/CONSULTANTS
No Contracts/Consultants Costs Requested
Instructions: See the program-specific Application Guide for a list of allowable/unallowable costs for the particular
program to which you are applying. Please limit your descriptions to 1000 characters.
1. Contracts: Provide a cost estimate for the product or service to be procured by contract. Applicants are
encouraged to promote free and open competition in awarding contracts. If awarded, requests for sole source
procurements of equipment, technology, or services in excess of $100,000 must be submitted to the COPS Office for
prior approval. (See Application Guide for more information on the required submission.)
Contract Name
Description
Per Contract Subtotal
$
$
$
Contract Subtotal:
$
2. Consultant Fees: For each consultant enter the name (if known), service to be provided, hourly or daily fee (based
upon an 8-hour day), and estimated length of time on the project. Unless otherwise approved by the COPS Office,
approved consultant rates will be based on the salary a consultant receives from his or her primary employer.
Consultant fees in excess of $550 per day require additional written justification and must be pre-approved in writing
by the COPS Office if the consultant is hired via a noncompetitive bidding process.
Consultant Name/Title
Service Provided
Computation
( Cost X # Days)
Description
Per Consultant
Fee Subtotal
(
X
) $
(
X
) $
(
X
) $
Consultant Fees Subtotal: $
3. Consultant Travel: List all travel-related expenses to be paid from the grant to the individual consultants (e.g.,
transportation, meals, lodging) separate from their consultant fees.
Consultant Name/
Event Title
Event Costs
Registration $
Per diem
$
Registration $
Per diem
$
Number Per Consultant
of Staff Travel Subtotal
Transportation $
Lodging
$
$
Transportation $
Lodging
$
$
Description
Consultant Travel Subtotal: $
4. Consultant Expenses: List all travel-related expenses to be paid from the grant to the individual consultants
separate from their consultant fees and travel expenses (e.g., computer equipment and office supplies).
Consultant Name/Title
Item(s)
Per Consultant
Expenses Subtotal
Description
$
$
Consultant Expenses Subtotal: $
Contracts/Consultants
Total:
(Contracts (F1) + Consultant Fees (F2) +
Consultant Travel (F3) + Consultant Expenses (F4))
$
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Standard Application Forms
No Other Costs Requested
G. OTHER COSTS
Instructions: List other requested items that will support the project goals and objectives as outlined in your
application. Provide a specific description for each item and explain how the item supports the project
goals and objectives as outlined in your application.
Please be advised that, to the greatest extent practical, all equipment and products purchased with these funds
must be American-made.
See the program-specific Application Guide for a list of allowable/unallowable costs for this program.
Agencies are encouraged to limit their requests to the lines shown below and group similar items together so
that all items are accounted for on the budget worksheet for each category. However, if your agency requires
more than lines please check the available box. Please limit your descriptions to 1000 characters.
Item Name
More Other Costs
Entries Required
Computation
(# of Items/Units X Unit Cost)
Per Item Subtotal
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
(
X
)
$
Other Costs Total: $
Description
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Standard Application Forms
H. INDIRECT COSTS
No Indirect Costs Requested
Instructions: Indirect costs are allowed under a very limited number of COPS programs. Please see the programspecific Application Guide for a list of allowable/unallowable costs for the particular program to which you are
applying.
If indirect costs are requested, a copy of the agency's fully-executed, negotiated Federal Rate Approval Agreement must
be attached to this application. Please limit your descriptions to 1000 characters.
[If CHP and Tribal Agency, the text below will be displayed as second paragraph above.]
If your organization is requesting indirect costs for this project, please include a copy of your current, signed federallyapproved indirect Cost Rate Negotiated Agreement. If the applicant does not have an approved rate, a rate can be
requested by contacting the applicant's cognizant federal agency, which will review all documentation and approve a
rate for the applicant organization. Please limit your description to 1000 characters .
Indirect Cost Description
Approved Indirect Cost Rate
Indirect Cost Total
$
More Indirect Costs
Entries Required
Indirect Costs Total: $
Description
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Standard Application Forms
BUDGET SUMMARY
Instructions: Please review the category totals and the total project costs below. If the category totals and
project amounts shown are correct, please continue with the submission of your application. Should you need
to make revisions to a budget category, click the “Edit” button for that category.
Note: Agencies applying for Secure Our Schools (SOS) must enter a “Total Local Share Amount” percentage of 50% in the designated area below.
Applicants for all other Fiscal Year 2011 COPS Grants are not required to provide a local match.
Budget Category
Category Total
A.
Sworn Officer Positions
$
B.
Sworn Officer Fringe Benefits
$
C.
Civilian/Non-Sworn Personnel
$
D.
Civilian/Non-Sworn Fringe Benefits
$
E.
Equipment/Technology
$
F.
Supplies
$
G.
Travel/Training
$
H.
Contracts/Consultants
$
I.
Other Costs
$
J.
Indirect Costs
$
Total Project Amount:
Total Federal Share Amount:
(Total Project Amount X Federal Share Percentage Allowable)
Total Local Share Amount (If applicable):
(Total Project Amount - Total Federal Share Amount)
Edit
$
$
%
$
%
Contact Information for Budget Questions
Please provide contact information of the financial official that the COPS Office may contact with questions
related to your budget submission.
Authorized Official’s Typed Name:
Title:
Phone:
Fax:
E-mail Address:
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Standard Application Forms
SECTION 15A: ASSURANCES
Several provisions of federal law and policy apply to all grant programs. The Office of Community Oriented Policing Services needs to secure your assurance
that the applicant will comply with these provisions. If you would like further information about any of these assurances, please contact your state’s COPS
Grant Program Specialist at 800-421-6770.
By signing this form, the applicant assures that it will comply with all legal and administrative requirements that govern the applicant for acceptance and use
of federal grant funds. In particular, the applicant assures us that:
1.
It has been legally and officially authorized by the appropriate governing body (for example, mayor or city council) to apply for this grant and that the
persons signing the application and these assurances on its behalf are authorized to do so and to act on its behalf with respect to any issues that may arise
during processing of this application.
2.
It will comply with the provisions of federal law, which limit certain political activities of grantee employees whose principal employment is in
connection with an activity financed in whole or in part with this grant. These restrictions are set forth in 5 U.S.C. § 1501, et seq.
3.
It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act, if applicable.
4.
It will establish safeguards, if it has not done so already, to prohibit employees from using their positions for a purpose that is, or gives the appearance of
being, motivated by a desire for private gain for themselves or others, particularly those with whom they have family, business or other ties.
5.
It will give the Department of Justice or the Comptroller General access to and the right to examine records and documents related to the grant.
6.
It will comply with all requirements imposed by the Department of Justice as a condition or administrative requirement of the grant, including but not
limited to: the requirements of 28 CFR Part 66 and 28 CFR Part 70 (governing administrative requirements for grants and cooperative agreements); 2
CFR Part 225 (OMB Circular A-87), 2 CFR 220 (OMB Circular A-21), 2 CFR Part 230 (OMB Circular A-122) and 48 CFR Part 31.000, et seq. (FAR
31) (governing cost principles); OMB Circular A-133 (governing audits) and other applicable OMB circulars; the applicable provisions of the Omnibus
Crime Control and Safe Streets Act of 1968, as amended; 28 CFR Part 38.1; the applicable COPS Application Guidelines; the applicable COPS Grant
Owner's Manuals; and with all other applicable program requirements, laws, orders, regulations, or circulars.
7.
It will, to the extent practicable and consistent with applicable law, seek, recruit and hire qualified members of racial and ethnic minority groups and
qualified women in order to further effective law enforcement by increasing their ranks within the sworn positions in the agency.
8.
It will not (and will require any subgrantees, contractors, successors, transferees, and assignees not to), on the ground of race, color, religion, national
origin, sex, disability, or age, unlawfully exclude any person from participation in, deny the benefits of or employment to any person, or subject any
person to discrimination in connection with any programs or activities funded in whole or in part with federal funds. These civil rights requirements are
found in the non-discrimination provisions of Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C. § 2000d); the Omnibus Crime Control and
Safe Streets Act of 1968, as amended (42 U.S.C. § 3789d); Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794); the Age
Discrimination Act of 1975 (42 U.S.C. §6101, et seq.); Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681 et seq.); and the
corresponding DOJ regulations implementing those statutes at 28 C.F.R. part 42 (subparts C, D, E, G, and I). It will also comply with Executive Order
13279 Equal Treatment for Faith-Based Organizations and its implementing regulations at 28 C.F.R Part 38, which requires equal treatment of religious
organizations in the funding process and nondiscrimination of beneficiaries by Faith-Based Organizations on the basis of belief or non-belief.
A. In the event that any court or administrative agency makes a finding of discrimination on grounds of race, color, religion, national origin, gender,
disability or age against the applicant after a due process hearing, it agrees to forward a copy of the finding to the Office for Civil Rights, Office of
Justice Programs, 810 7th Street, NW, Washington, D.C. 20531.
9.
B. If your organization has received an award for $500,000 or more and has 50 or more employees, then it has to prepare an Equal Employment
Opportunity Plan (EEOP) and submit it to the Office for Civil Rights (“OCR”), Office of Justice Programs, 810 7th Street, N.W., Washington, DC
20531, for review within 60 days of the notification of the award. If your organization received an award between $25,000 and $500,000 and has 50 or
more employees, your organization still has to prepare an EEOP, but it does not have to submit the EEOP to OCR for review. Instead, your
organization has to maintain the EEOP on file and make it available for review on request. In addition, your organization has to complete Section B of
the Certification Form and return it to OCR. If your organization received an award for less than $25,000; or if your organization has less than 50
employees, regardless of the amount of the award; or if your organization is a medical institution, educational institution, nonprofit organization or
Indian tribe, then your organization is exempt from the EEOP requirement. However, your organization must complete Section A of the Certification
Form and return it to OCR.
Pursuant to Department of Justice guidelines (June 18, 2002 Federal Register (Volume 67, Number 117, pages 41455-41472)), under Title VI of the Civil
Rights Act of 1964, it will ensure meaningful access to its programs and activities by persons with limited English proficiency.
10. It will ensure that any facilities under its ownership, lease or supervision which shall be utilized in the accomplishment of the project are not listed on the
Environmental Protection Agency’ (EPA) list of Violating Facilities and that it will notify us if advised by the EPA that a facility to be used in this grant
is under consideration for such listing by the EPA.
11. If the applicant’s state has established a review and comment procedure under Executive Order 12372 and has selected this program for review, it has
made this application available for review by the state Single Point of Contact.
12. It will submit all surveys, interview protocols, and other information collections to the COPS Office for submission to the Office of Management and
Budget for clearance under the Paperwork Reduction Act of 1995 if required.
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13. It will comply with the Human Subjects Research Risk Protections requirements of 28 CFR Part 46 if any part of the funded project contains non-exempt
research or statistical activities which involve human subjects and also with 28 CFR Part 22, requiring the safeguarding of individually identifiable
information collected from research participants.
14. Pursuant to Executive Order 13043, it will enforce on-the-job seat belt policies and programs for employees when operating agency-owned, rented or
personally-owned vehicles.
15. It will not use COPS funds to supplant (replace) state, local, or Bureau of Indian Affairs funds that otherwise would be made available for the purposes of
this grant, as applicable.
16. If the awarded grant contains a retention requirement, it will retain the increased officer staffing level and/or the increased officer redeployment level, as
applicable, with state or local funds for a minimum of 12 months following expiration of the grant period.
17. It will not use any federal funding directly or indirectly to influence in any manner a Member of Congress, a jurisdiction, or an official of any
government, to favor, adopt, or oppose, by vote or otherwise, any legislation, law ratification, policy or appropriation whether before or after the
introduction of any bill, measure, or resolution proposing such legislation, law, ratification, policy or appropriation as set forth in the Anti- Lobby Act, 18
U.S.C. 1913.
18. In the event that a portion of grant reimbursements are seized to pay off delinquent federal debts through the Treasury Offset Program or other debt
collection process, it agrees to increase the non-federal share (or, if the awarded grant does not contain a cost sharing requirement, contribute a nonfederal share) equal to the amount seized in order to fully implement the grant project.
19.
None of the funds made available under the FY 2012 Appropriations Act (Public Law 122-55) may be distributed to the Association of Community
Organizations for Reform Now (ACORN) or its subsidiaries.
False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines, imprisonment, disbarment from
participating in federal grants or contracts, and/or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.
Elections or other selections of new officials will not relieve the grantee entity of its obligations under this grant.
________________________________________________
_________________________
Signature of Law Enforcement Executive/Agency Executive
Date
(For your electronic signature, please type in your name)
________________________________________________
Signature of Government Executive/Financial Official
_________________________
Date
(For your electronic signature, please type in your name)
Rev. 12/2010
e08097228
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Standard Application Forms
SECTION 15B: CERTIFICATIONS
Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; Federal Taxes and Assessments; Drug-Free Workplace
Requirements; and Coordination with Affected Agencies.
Although the Department of Justice has made every effort to simplify the application process, other provisions of federal law require us to seek your agency’s
certification regarding certain matters. Applicants should read the regulations cited below and the instructions for certification included in the regulations to
understand the requirements and whether they apply to a particular applicant. Signing this form complies with certification requirements under 28 CFR Part 69,
“New Restrictions on Lobbying,” 2 CFR Part 2867, “Nonprocurement Debarment and Suspension,” Public Law 111-117 or the most recent applicable
appropriations Act, 28 CFR Part 83, “Government-Wide Requirements for Drug-Free Workplace (Grants),” and the coordination requirements of the Public
Safety Partnership and Community Policing Act of 1994. The certifications shall be treated as a material representation of fact upon which reliance will be
placed when the Department of Justice determines to award the covered grant.
1. Lobbying
As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons entering into a grant or cooperative agreement over
$100,000, as defined at 28 CFR Part 69, the applicant certifies that:
A. 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 making of any federal grant; the entering into of any cooperative agreement; and the extension, continuation, renewal,
amendment or modification of any federal grant or cooperative agreement;
B. 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 of Lobbying Activities,” in
accordance with its instructions; and
C. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including
subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all sub-recipients shall certify and disclose accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
Pursuant to Executive Order 12549, Debarment and Suspension, as implemented at 2 CFR Part 2867, for prospective participants in primary covered
transactions, as defined at 2 CFR Part 2867.20(a), and other requirements, the applicant certifies that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of federal benefits by a state or federal court,
or voluntarily excluded from covered transactions by any federal department or agency;
B. Have not within a three-year period preceding this application been convicted of a felony criminal violation under any Federal law, or been convicted
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) or private agreement or transaction; violation of federal or state antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion or receiving stolen property, making
false claims, or obstruction of justice, or commission of any offense indicating a lack of business integrity or business honesty that seriously and
directly affects your present responsibility;
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 (A)(ii) of this certification; and
D. Have not within a three-year period preceding this application had one or more public transactions (federal, state or local) terminated for cause or
default.
3. Federal Taxes and Assessments
A. If applicable, an applicant who receives an award in excess of $5,000,000 certifies that, to the best of its knowledge and belief, the applicant has filed
all Federal tax returns required during the three years preceding the certification, has not been convicted of a criminal offense under the Internal
Revenue Code of 1986, and has not, more than 90 days prior to certification, been notified of any unpaid Federal tax assessment for which the liability
remains unsatisfied, unless the assessment is the subject of an installment agreement or offer in compromise that has been approved by the Internal
Revenue Service and is not in default, or the assessment is the subject of a non-frivolous administrative or judicial proceeding.
B. The applicant certifies that it does not have any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies
have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting
the tax liability.
4. Drug-Free Workplace (Grantees Other Than Individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 83, for grantees/recipients, as defined at 28 CFR Part 83.660 A. The applicant certifies that it will, or will continue to, provide a drug-free workplace by:
(i) Publishing a statement notifying employees that the 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;
(ii) Establishing an on-going drug-free awareness program to inform employees about (a) The dangers of drug abuse in the workplace;
(b) The grantee’s policy of maintaining a drug-free workplace;
(c) Any available drug counseling, rehabilitation and employee assistance programs; and
(d) The penalties that may be imposed upon employees for drug-abuse violations occurring in the workplace;
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(iii) 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
(i);
(iv) Notifying the employee in the statement required by paragraph (i) that, as a condition of employment under the grant, the employee will -
(a) Abide by the terms of the statement; and
(b) 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 five
calendar days after such conviction;
(v) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (iv)(b) from an employee or otherwise
receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to: COPS Office, 145 N
St, NE, Washington, D.C. 20530. Notice shall include the identification number(s) of each affected grant;
(vi) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (iv)(b), with respect to any employee who is
so convicted (a) 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
(b) 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;
(vii) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (i), (ii), (iii), (iv), (v), and (vi).
Grantee Agency Name and Address:
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.
5. The Public Safety Partnership and Community Policing Act of 1994 requires applicants to certify that there has been appropriate coordination with all
agencies that may be affected by the applicant’s grant proposal if approved. Affected agencies may include, among others, the Office of the United States
Attorney, state or local prosecutors, or correctional agencies. The applicant certifies that there has been appropriate coordination with all affected
agencies.
Where the applicant is unable to certify to any of the statements in this Certifications form, he or she shall attach an explanation to this application
regarding the particular statement that cannot be certified. Please check here
if an explanation is attached to this application. Please note that the
applicant is still required to sign the Certifications form to certify to all the other applicable statements.
Grantee Agency Name and Address:
Grantee IRS/ Vendor Number:
False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines, imprisonment, disbarment from
participating in federal grants or contracts, and/or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.
Elections or other selections of new officials will not relieve the grantee entity of its obligations under this grant.
__________________________________________________
Signature of Law Enforcement Executive/Agency Executive
(For your electronic signature, please type in your name)
__________________________________________________
Signature of Government Executive/Financial Official
(For your electronic signature, please type in your name)
________________________
Date
________________________
Date
Rev. 12/2010
e08097228
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SECTION 16: DISCLOSURE OF LOBBYING ACTIVITIES
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to
make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial
filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1.
Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2.
Identify the status of the covered Federal action.
3.
Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported,
enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered
Federal action.
4.
Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate
classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the
first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5.
If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6.
Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known.
For example, Department of Transportation, United States Coast Guard.
7.
Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8.
Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9.
For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number.
The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10
minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.
Standard Application Forms
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Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post-award
For Material Change Only:
d. loan
year _________ quarter _________
e. loan guarantee
date of last report ______________
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
Subawardee
and Address of Prime:
Prime
Tier ______, if known :
Congressional District, if known : 4c
6. Federal Department/Agency:
Congressional District, if known :
7. Federal Program Name/Description:
CFDA Number, if applicable : _____________
8. Federal Action Number, if known :
9. Award Amount, if known :
$
10. a. Name and Address of Lobbying Registrant
( if individual, last name, first name, MI ):
b. Individuals Performing Services (including address if
different from No. 10a )
( last name, first name, MI ):
requested through this form is authorized by title 31 U.S.C. section
11. Information
1352. This disclosure of lobbying activities is a material representation of fact
Signature:
upon which reliance was placed by the tier above when this transaction was made
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be available for public inspection. Any person who fails to file the
required disclosure shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
Print Name:
Title:
Telephone No.: _______________________ Date:
Federal Use Only:
Approved by OMB
0348-0046
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
ORI#
Standard Application Forms
SECTION 17: REVIEWS AND CERTIFICATIONS
1) Federal Civil Rights and Grant Reviews:
Please be advised that an application may not be funded and, if awarded, a hold may be placed on the award if it is
deemed that the applicant is not in compliance with federal civil rights laws, and/or is not cooperating with an ongoing
federal civil rights investigation, and/or is not cooperating with a Department of Justice grant review or audit.
2) Certification of Review of 28 C.F.R. Part 23/Criminal Intelligence Systems:
Please review the COPS Application Guide: Legal Requirements Section for additional information.
Please check one of the following, as applicable to your agency’s intended use of this grant:
No, my agency will not use these COPS grant funds (if awarded) to operate an interjurisdictional criminal
intelligence system.
Yes, my agency will use these COPS grant funds (if awarded) to operate an interjurisdictional criminal
intelligence system. By signing below, we assure that our agency will comply with the requirements of 28 C.F.R.
Part 23.
3) Certification of Review and Representation of Compliance with Requirements:
The signatures of the Law Enforcement Executive/Agency Executive, Government Executive/Financial Official, and
the Person Submitting this Application on the Reviews and Certifications represent to the COPS Office that:
a) the signatories have been legally and officially authorized by the appropriate governing body to submit this
application and act on behalf of the grant applicant entity;
b) the applicant will comply with all legal, administrative, and programmatic requirements that govern the
applicant for acceptance and use of federal funds as outlined in the applicable COPS Application Guide; the COPS
Grant Owner’s Manual, Assurances, Certifications and all other applicable program regulations, laws, orders, and
circulars;
c) the applicant understands that false statements or claims made in connection with COPS programs may result in
fines, imprisonment, debarment from participating in federal grants, cooperative agreements, or contracts, and/or
any other remedy available by law to the federal government; AND
d) the information provided in this application, including any amendments, shall be treated as material
representations of fact upon which reliance will be placed when the Department of Justice determines to award the
covered grant.
The signatures of the Law Enforcement Executive/Agency Executive and the Government Executive/Financial Official
on this application must be the same as those identified in Section 4 of this application. Applications with missing,
incomplete, or inaccurate signatories or responses may not be considered for funding.
ORI#
Standard Application Forms
______________________________________________
Signature of Law Enforcement Executive/Agency Executive
(For your electronic signature, please type in your name)
______________________________________________
Signature of Government Executive/Financial Official
(For your electronic signature, please type in your name)
______________________________________________
Signature of the Person Submitting This Application
(For your electronic signature, please type in your name)
___________________
Date
___________________
Date
___________________
Date
By clicking this box, the applicant understands that the use of typed names in this grant application and the required
grant forms, including the Assurances and Certifications, constitute electronic signatures and that the electronic
signatures are the legal equivalent of handwritten signatures.
ORI#
Standard Application Forms
SECTION 18: APPLICATION DATA VERIFICATION
By signing below, I certify that I have read, understand and agree to the following:
a)
my agency has been requested by the COPS Office to review, confirm and/or update specific data items that
were previously submitted in our COPS application and our failure to respond to the request may eliminate
our application from 2011 funding consideration;
b)
my agency has reviewed, confirmed and/or updated the specific data items identified by the COPS Office,
and certify that the information is true and accurate;
c)
I am authorized by the appropriate governing body to act on behalf of the grant applicant entity to make
changes to our COPS application which will be considered for 2011 funding;
d)
the information provided in this application, including any amendments, shall be treated as material
representations of fact upon which reliance will be placed when the Department of Justice determines to
award the covered grant; and
e)
the applicant understands that false statements or claims made in connection with COPS programs may
result in fines, imprisonment, debarment from participating in federal grants, cooperative agreements, or
contracts, and/or any other remedy available by law to the federal government.
______________________________________________
Signature of the Person Completing this Form
Date Completed
(For your electronic signature, please type in your name)
ELECTRONIC SIGNATURE: By clicking this box , I understand that typing in my name on this form constitutes
an electronic signature and that the electronic signature is the legal equivalent of a handwritten signature.
In order for your agency to be considered for COPS grant funding, all application updates must be submitted through
the COPS website (www.cops.usdoj.gov) by <>. For technical assistance with submitting your updates or
to withdraw your agency's application from funding consideration, please call the COPS Office Response Center at
800-421-6770.
ORI#
Standard Application Forms
Paperwork Reduction Act Notice
The public reporting burden for this collection of information is estimated to be up to 11.3 hours per response,
depending upon the COPS program being applied for, which includes time for reviewing instructions. Send comments
regarding this burden estimate or any other aspects of the collection of this information, including suggestions for
reducing this burden, to the Office of Community Oriented Policing Services, U.S. Department of Justice, 145 N
Street, NE, Washington, DC 20530; and to the Public Use Reports Project, Office of Information and Regulatory
Affairs, Office of Management and Budget, Washington, DC 20503.
You are not required to respond to this collection of information unless it displays a valid OMB control number. The
OMB control number for this application is 1103-0098 and the expiration date is 05/31/2013.
FOR MORE INFORMATION:
U.S. Department of Justice
Office of Community Oriented Policing Services
145 N Street, NE
Washington, DC 20530
To obtain details on COPS programs, call the
COPS Office Response Center at 800-421-6770
Visit COPS Online at www.cops.usdoj.gov.
e011011250
Revised Date: January 2011
| File Type | application/pdf |
| File Modified | 2012-01-13 |
| File Created | 2011-12-01 |