Form 1 AmeriCorps Affiliate Instructions

AmeriCorps Affiliate

Application Instructions

IMPORTANT NOTICES

Federal Agency Name: Corporation for National and Community Service

Opportunity Title: AmeriCorps Affiliate FY [Applicable Year of Funding]

Public Burden Statement: Public reporting burden for this collection of information is estimated to average 20 hours per submission, including reviewing instructions, gathering and maintaining the data needed, and completing the application and reporting forms. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, at: [email protected]. CNCS informs people who may respond to this collection of information that they are not required to respond to the collection of information unless the OMB control number and expiration date displayed on page one (1) are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).

Universal Identifier: Applications must include a Dun and Bradstreet Data Universal Numbering System (DUNS) number and register with the System for Award Management (SAM, www.sam.gov) and maintain an active SAM registration until the application process is complete and, should a grant be made, throughout the life of the award.

CNCS will consider requests to designate a certain number of positions as National Service Positions. Applicants may only request designation of positions as National Service Positions; CNCS will not award financial resources to applicants. Individuals who successfully complete a term of service in the designated positions may receive a Segal AmeriCorps Affiliate designations are intended to use national service as a means to incubate and expand service opportunities to create self-sustaining service models that complement existing AmeriCorps programs.

Application Resources

Please use the following application instructions if you are a new applicant applying for AmeriCorps Affiliate or if you are continuing your AmeriCorps Affiliate agreement.

Use these instructions in conjunction with the AmeriCorps Affiliate Notice for the year in which you are applying. The Notice includes deadlines, eligibility requirements, submission requirements, funding priorities and other relevant information that might change annually.

If you are submitting a request for continuation, you will open your existing application and enter new information in the Continuation Changes field, or as directed by your Program Officer.

How to Apply

Create an eGrants Account

This step applies only to organizations that do not currently have an eGrants account.

Please create an eGrants account. Establish an eGrants account by accessing this link: https://egrants.cns.gov/espan/main/login.jsp and selecting “Don’t have an eGrants account? Create an account.” Complete the following sections in eGrants to establish an account:

• Login Information: Includes primary contact name

• Review and accept the System Rule of Behavior

• EIN Number

• Organizational Profile/Organization Information:

  • Organization Name

  • DUNS Number (optional)

  • Organization Type

  • Primary Address

  • Phone Number

  • Email Address

• Indirect Cost Rate Record: Select “No” for the question “Do you have an Indirect Cost Rate Record?”

• Click the Submit button to establish the account

In eGrants, to begin to apply you will need to:

• Start a new Grant Application

• Select a Program Area (AmeriCorps Affiliate)

• Select the NOFA: [Applicable Year of Funding] AmeriCorps Affiliate

Once you have initiated an application, it will be listed in the View My Grants/Applications section of your homepage. If you exit and then return to eGrants and wish to continue entering or editing your application, please open your saved version by selecting “View My Grants/applications”. You should not use the “New” button again as this will start a brand new application.

Application Components

Your application consists of the following components. Please make sure to complete each section.

I. Applicant Info

II. Application Info

III. Narratives

1. Executive Summary

2. Program Design

3. Organizational Capacity

4. Cost-Effectiveness and Budget Adequacy

IV. Performance Measures

V. Review, Authorize and Submit

Information entered in the Applicant Info and Application Info sections will populate the SF 424 Facesheet.

I. Applicant Info

In eGrants, complete the Applicant Info Section. This section is particularly important for data collection and evaluation. Please take the time to describe your proposed program activities accurately in this section.

• Continuation Requests: Select “Continuation/Renewal” if you are continuing. Use the view/edit link to review the project name and address and update as necessary and confirm that the project name associated with this request matches the project name used last year.

• New Applicants: Select “New” only if you are applying for the first time or applying for a new grant when you are completing a three year project period. If you are applying as new, enter your project information into the fields that appear.

• Project Information: Enter the name and location of the project, the state in which the members will be serving, and the name and contact information for the project director. Then select characteristics that fit your project under Program Design, Program Location, and Program Focus.

• Project Director: Please enter the Executive Director or other authorizing executive who will certify the grant.

• Program Initiative: Leave blank.

• Program Website: Enter the project’s URL.

II. Application Info

In the Application Info Section please enter:

• Areas Affected by the Project: Please include the two-letter abbreviation with both letters capitalized for each state where you plan to operate. Separate each two letter state abbreviation with a comma. For city or county information, please follow each with the two-letter capitalized state abbreviation.

• Project Start and End Dates: If selected, your CNCS Program Officer will work with you to finalize your project start date.

• Intergovernmental Review of Federal Programs: If you are a state entity, check with your state prior to answering, otherwise check no.

• Delinquent on any Federal Debt: Check the appropriate box. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of debt include delinquent audit allowances, loans, and taxes. If ‘Yes’, type your explanation in the text box provided.

• State Application Identifier: Enter N/A

• Single Point of Contact: This is pre-filled as “No, this is not applicable.”

• The “Estimated Funds Requested” box will be populated automatically.

• Please note that the Authorized Representative will be filled in at the end of the application when completing the Assurances and Certifications section. The Authorized Representative will need to have his/her own account to click on the Assurances and Certifications at the end of the application.

Note: Falsification or concealment of a material fact or submission of false, fictitious or fraudulent statements or representations to any department or agency of the United States Government may result in a fine or imprisonment for not more than five (5) years, or both. (18 USC § 1001).

III. Narratives

The application narrative has four separate sections.

• Executive Summary

• Program Design

• Organizational Capability

• Budget Adequacy

Note: The Narratives Section also includes fields for Clarification Information, Amendment Justification, and Continuation Changes. Please enter N/A in these fields. They will be used at a later date to enter information for clarification review, to request amendments once a great is awarded, and to enter changes in the narrative in continuation requests.

Page Limit and Formatting

• It is important that you preview the eGrants PDF of your application to ensure that you don’t exceed the page limit as prescribed in the Notice. From the Review and Submit page, print out your application prior to final submission to ensure it is not over the page limit. This limit does not include the budget pages or performance measures.

• Bold face, bullets, underlines, charts, diagrams, and tables or other types of formatting will not copy into eGrants.

PROJECT NARRATIVE

The narrative is your opportunity to demonstrate to reviewers the utility of the proposed national service positions and project activities. At a minimum, the narrative should be responsive to the assessment criteria and must address each of the following five items, as specified below: Project Information, Executive Summary, Program Design, Organizational Capacity, and Budget Adequacy. Although the application is noncompetitive, reviewers will assess your application against the selection criteria in the Notice and request clarification where required. To best respond to the criteria in the Notice, include a brief discussion of each bullet as it pertains to your application.

1. Executive Summary

Please complete the executive summary per the guidance in the Notice.

2. Program Design

Describe the impact the program will have on the community need as described in the criteria in the Notice.

3. Organizational Capacity

Describe your organization’s capability to initiate and manage the proposed program in compliance with federal requirements as described in the criteria in the Notice.

4. Budget Adequacy

Describe your organization’s financial capacity to run the project according to the criteria in the Notice.

Performance Measures

Applicants must complete the performance measure module according to the requirements outlined in the Notice.

Review, Authorize and Submit

eGrants requires that you review and verify your entire application before submitting by completing the following sections in eGrants:

• Review

• Authorize

• Assurances

• Certifications

• Verify

• Submit

Read the Authorization, Assurances, and Certifications carefully (Appendix A). The person who authorizes the application must be the applicant’s Authorized Representative or his/her designee and must have an active eGrants account to sign these documents electronically. An Authorized Representative is the person in your organization authorized to accept and commit funds on behalf of the organization. A copy of the governing body’s authorization for this official representative to sign must be on file in the applicant’s office.

Be sure to check your entire application for errors before submitting it. eGrants will also generate a list of errors if there are sections that need to be corrected prior to submission when you verify the application. If someone else is acting in the role of the applicant’s authorized representative, that person must log into his/her eGrants account to proceed with Authorize and Submit. After signing off on the Authorization, Assurances, and Certifications, his/her name will override any previous signatory that may appear and show on the application as the Authorized Representative.

Note: Anyone within your organization who will be entering information in the application at any point during application preparation and submission in the eGrants system must have their own eGrants account. Individuals may establish an eGrants account by accessing this link: https://egrants.cns.gov/espan/main/login.jsp and selecting “Don’t have an eGrants account? Create an account.”

Continuation Requests

The following instructions for submitting a continuation request apply only to existing programs.

When to Submit Your Continuation Request:

See the instructions from your Program Officer.

How to Submit Your Continuation Request:

• Log into eGrants.

• Click Continuation/Renewal on your eGrants home page.

• You will be shown a list of applications that are eligible to be continued. Select the application you wish to continue. Make sure you select the correct one. Do not start a new application. The system will copy your most recently approved application into the continuation.

• Edit your continuation application as directed in the continuation request instructions below. When you have completed your work, click the SUBMIT button.

If you experience problems using eGrants, contact the eGrants Help Desk at (800) 942-2677 or online at http://www.nationalservice.gov/questions/app/ask.

What to Include in Your Continuation Request:

Application Content

Your application consists of the following components. Make sure to review each section.

1. Applicant Info

2. Application Info

3. Narratives

4. Performance Measures

5. Review, Authorize and Submit

I. Applicant Info

Update this section if necessary.

• In particular, click View/Edit under Project Director to see if the contact information is current. Make any necessary changes to the project director’s contact information.

• If the project director has changed, you must create a record for the new person by clicking Enter New. Do not overwrite the information for an existing contact with the information for a new contact as this affects the historical record.

• Document in the Continuation Changes field any changes you have made in this section.

II. Application Info

In the Application Info Section enter:

• Areas affected by your project. Please include the two-letter abbreviation with both letters capitalized for each state where you plan to operate. Separate each two-letter state abbreviation with a comma. For city or county information, please follow each one with the two-letter capitalized state abbreviation.

• Update the project period dates to align with those listed in the Notice.

• Indicate Yes or No if you are delinquent on any federal debt. If yes, send an explanation to your CNCS Program Officer.

• State Application Identifier: Enter N/A.

• The Application may be subject to State Review by Executive Order 12372 Process. If you are a state entity, check with your state prior to answering, otherwise check no.

• Document in the Continuation Changes Narrative field if you have updated the Application Info section.

• Leave the box for “Program Initiative” blank unless otherwise noted in the Notice.

III. Narratives

Your original application will appear in the Executive Summary and in the narrative sections Program Design, Organizational Capability, and Budget Adequacy, Clarification Summary, and Continuation Changes, as appropriate.

With the exception of the Executive Summary, do not enter continuation changes in the original narrative fields. If you are not proposing changes to your continuation request, simply leave your original narrative as it is, and enter “No Changes” in the Continuation Changes field.

Provide the following information in the Continuation Changes narrative field:

1. Identify whether this is a continuation and if yes, which year.

2. Did the program enroll 100% of the slots in the last full year of program operation? If no, provide an explanation and describe the plan for improvement.

3. Did the program retain 100% of the members in the last full year of program operation? If no, provide an explanation, and describe the plan for improvement. CNCS recognizes retention rates may vary among equally effective programs depending on the program model but expects all grantees to pursue the highest retention rate possible.

4. Was the program 100% compliant with 30-day enrollment and exit requirements? If no, provide an explanation and the plan to ensure future compliance.

5. Describe the manner and extent to which you consulted with the State Commission in the states in which you plan to operate (not applicable to Tribes.)

6. Are you proposing a change in operating sites or service locations? This includes expansion to new sites. If yes, describe these changes and provide a justification for the change. The justification should include the need that will be met at any new sites, the activities of the members, and organizational capacity to support new sites.

7. Are you proposing a change in program scope or design? If yes, describe the change and provide a justification.

8. Are you requesting an increase in members?

Continuation applicants requesting an increase in members should not modify performance measures to reflect the increase. Instead, please respond to the questions below. If your continuation request is approved, you will be invited to modify your performance measures and budget accordingly.

1. What is the level of increase being requested?

2. Provide a justification for the increase. The justification should include an explanation of the problem/need that will be met, how or whether member activities will differ from those already included in the approved project, and a description of the organizational capability to support the expansion, including the organizational staffing and experience to manage the expansion and ensure quality and compliant programming and member experience.

3. Provide a detailed description of how the expansion would change the number of Education Awards requested.

4. Provide a detailed description of how the expansion would change the application performance measures. Indicate how the expansion will impact program outcomes and make the program more effective.

9. Are you proposing other changes not captured above? If yes, describe these changes and provide a justification for them.

The page limit for the Continuation Changes field is 4 pages, as the pages print out from eGrants.

Executive Summary: Please update the summary of your proposed project as needed. The summary must include a summary of the project in less than 2,000 characters.

IV. Performance Measures

Your performance measures are copied from your previous year’s application into your continuation application. If you are proposing changes to your program, such as adding or changing grant funded activities, you may need to revise your performance measures.

To revise performance measures, click to View/Edit the performance measures that copy over from your original application, or add new performance measures. Note in the Continuation Changes field that you have updated performance measures.

APPENDIX A: ASSURANCES AND CERTIFICATIONS

ASSURANCES

 

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that the applicant:

 

• Has the legal authority to apply for federal assistance, and the institutional, managerial, and financial capability (including funds sufficient to pay the non-federal share of project costs) to ensure proper planning, management, and completion of the project described in this application.

• Will give the Corporation for National and Community Service (CNCS), the CNCS Inspector General, the Comptroller General of the United States, and if appropriate, the state, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

• Will initiate and complete the activities described in the application within the applicable time frame after receipt of CNCS’s approval..

• Will comply with all federal statutes relating to nondiscrimination, including any self-evaluation requirements. These include but are not limited to:

1. Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et.seq.), which prohibits federal grantees from discriminating on the basis of race, color, or national origin;

2. Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex in an educational program or activity that receives or benefits from federal financial assistance;

3. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits federal grantees from discriminating on the basis of disability;

4. The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits the exclusion of any person on the basis of age from participating in any program or activity receiving federal financial assistance;

5. Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of dwellings provided in whole or in part with the aid of CNCS funding;

6. Any other nondiscrimination provisions in the National and Community Service Act of 1990, as amended (NCSA), or the Domestic Volunteer Service Act of 1973, as amended (DVSA); and

7. The requirements of any other nondiscrimination statute(s) which may apply to the application.

• Will comply with section 543 of the Public Health Service Act of 1912 (42 U.S.C. 290dd-2), as amended, relating to confidentiality of alcohol and drug abuse patient records.

• If a governmental entity—

1. Will comply with the requirements of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (42 U.S.C. 2601 et seq.), which govern the treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs, and

2. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

• Will assist CNCS in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-l et seq.).

• Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984, as amended, and 2 CFR Part 200, Subpart F.

• Will, when issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with CNCS funds, clearly state— (1) the percentage of the total costs of the program or project which will be financed with Federal money; (2) the dollar amount of Federal funds for the project or program; and (3) percentage and dollar amount of the total costs of the project or program that will be financed by non-governmental sources.

• Will not provide any CNCS funding to the Association of Community Organizations for Reform Now (ACORN), or any of its affiliates, subsidiaries, allied organizations, or successors.

• Will comply with all applicable requirements of all other federal laws, executive orders, regulations, application guidelines, and policies governing the program under which the application is filed.

For Applicants for awards under Subtitle C of the NCSA ONLY

If you are not applying for an award under Subtitle C of the NCSA (AmeriCorps State and National AmeriCorps Tribal, State Commission Support, etc), you may ignore this section.

• Will comply with all rules regarding prohibited activities, including those stated in applicable Notice, grant provisions, and program regulations, and will ensure that no assistance made available by the CNCS will be used to support any such prohibited activities.

• Will comply with the nondiscrimination provisions in the NCSA, which provide that an individual with responsibility for the operation of a project or program that receives assistance under the NCSA shall not discriminate against a participant in, or member of the staff of, such project or program on the basis of race, color, national origin, sex, age, political affiliation, disability, or religion.

• (NOTE: the prohibition on religious discrimination does not apply to the employment of any staff member paid with non-CNCS funds or paid with CNCS funds but employed with the applicant organization prior to or on the date the grant was awarded. If your organization is a faith-based organization that makes hiring decisions on the basis of religious belief, your organization may be entitled, under the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb, to receive federal funds and yet maintain that hiring practice, even though the NCSA includes a restriction on religious discrimination in employment of staff hired to work on a CNCS-funded project and paid with CNCS grant funds. (42 U.S.C. § 5057(c)). For the circumstances under which this may occur, please see the document “Effect of the Religious Freedom Restoration Act on Faith-Based Applicants for Grants” at: https://www.justice.gov/archive/fbci/effect-rfra.pdf.

• Will provide, in the design, recruitment, and operation of any AmeriCorps program, for broad-based input from – (1) the community served, the municipality and government of the county (if appropriate) in which the community is located, and potential participants in the program; and (2) community-based agencies with a demonstrated record of experience in providing services and local labor organizations representing employees of service sponsors, if these entities exist in the area to be served by the program;

• Will, prior to the placement of participants, consult with the appropriate local labor organization, if any, representing employees in the area who are engaged in the same or similar work as that proposed to be carried out by an AmeriCorps program, to ensure compliance with the non-displacement requirements specified in section 177 of the NCSA;

• Will, in the case of an AmeriCorps program that is not funded through a state, consult with and coordinate activities with the State Commission for the state in which the program operates;

• Will ensure that any national service program carried out by the applicant using assistance provided under section 121 of the NCSA and any national service program supported by a grant made by the applicant using such assistance will address unmet human, educational, environmental, or public safety needs through services that provide a direct benefit to the community in which the service is performed;

• Will comply with the non-duplication and non-displacement requirements set out in section 177 of the NCSA, and in CNCS’s regulations at 45 CFR § 2540.100;

• Will comply with the grievance procedure requirements as set out in section 176(f) of the NSCA and in CNCS’s regulations at 45 CFR § 2540.230;

• Will provide participants in the national service program with the training, skills, and knowledge necessary for the projects that participants are called upon to perform;

• Will provide support services to participants, such as information regarding G.E.D. attainment and post-service employment, and, if appropriate, opportunities for participants to reflect on their service experiences;

• Will arrange for an independent evaluation of any national service program that is carried out using assistance provided to the applicant under section 121 of the NCSA and 45 C.F.R. Part 2522, Subpart E; or, with the approval of CNCS, conduct an internal evaluation of the program;

• Will apply measurable performance goals and evaluation methods, which are to be used as part of such evaluation to determine the program’s impact on communities and persons served by the program, on participants who take part in the projects, and in other such areas as required by CNCS;

• Will ensure the provision of a living allowance and other benefits to participants as required by CNCS;

• Has not violated a federal criminal statute;

• If a state applicant, will ensure that the state subgrants that will be used to support national service programs are selected in conformance with the requirements of the NCSA;

• If a state applicant, will seek to ensure an equitable allocation within the state of assistance and approved national service positions, taking into consideration such factors as the locations of the programs, population density, and economic distress;

• If a state applicant, will ensure that not less than 60% of the assistance will be used to make grants to support national service programs other than those carried out by a state agency, unless CNCS approves otherwise based upon the state applicant not having a sufficient number of acceptable applications to meet the 60% threshold.

For Social Innovation Fund Applicants ONLY

If you are not applying for a Social Innovation Fund grant, you may disregard this section.

• Will use the funds received through the award in order to make subgrants to community organizations that will use the funds to replicate or expand proven initiatives, or support new initiatives, in low-income communities.

• Will consult with a diverse cross section of community representatives in making decisions about subgrants for communities (including individuals from the public, nonprofit private, and for-profit private sectors).

• Will make subgrants of a sufficient size and scope to enable the community organizations to build their capacity to manage initiatives, and sustain replication or expansion of the initiatives;

• Will not make any subgrants to:

1. The parent organizations of the applicant,

2. A subsidiary organization of the parent organization of the applicant, or,

3. If the applicant applied for a SIF award as a partnership, any member of the partnership.

• Commits to meeting the matching fund requirements of section 198k(i) of the NCSA (42 U.S.C. §12653k(i)).

• Commits to use data and evaluations to improve the applicant’s own model and to improve the initiatives funded by the applicant.

• Commits to cooperate with any evaluation activities undertaken by CNCS.

For Foster Grandparent Program, Senior Companion Program, Retired and Senior Volunteer Program, and Volunteers in Service to America Program Applicants ONLY

If you are not applying for an FGP, SCP, RSVP or VISTA grant, you may disregard this section.

• Will comply with the nondiscrimination provisions in the DVSA, which provide that an individual with responsibility for the operation of a project or program that receives assistance under the DVSA shall not discriminate against a participant in, or member of the staff of, such project or program on the basis of race, color, national origin, sex, age, political affiliation, disability, or on the basis of religion.

(NOTE: the prohibition on religious discrimination does not apply to the employment of any staff member paid with non-CNCS funds or paid with CNCS funds but employed with the applicant organization prior to or on the date the grant was awarded. If your organization is a faith-based organization that makes hiring decisions on the basis of religious belief, your organization may be entitled, under the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb, to receive federal funds and yet maintain that hiring practice, even though the DVSA includes a restriction on religious discrimination in employment of staff hired to work on a CNCS-funded project and paid with CNCS grant funds. (42 U.S.C. § 5057(c)). For the circumstances under which this may occur, please see the document “Effect of the Religious Freedom Restoration Act on Faith-Based Applicants for Grants” at: https://www.justice.gov/archive/fbci/effect-rfra.pdf

CERTIFICATIONS

The certifications set out below are material representations upon which the Corporation for National and Community Service (CNCS) will rely when it determines to award a grant. False certification, or violation of the certification, may be grounds for suspension of payments, suspension or termination of grants, or government-wide suspension or debarment (see 2 CFR Part 180, Subparts G and H).

 

Certification – Debarment, Suspension, and Other Responsibility Matters

This certification is required by OMB Guidelines to Agencies on Governmentwide Debarment and Suspension (Nonprocurement), 2 CFR Part 180, Section 180.335, What information must I provide before entering into a covered transaction with a Federal agency?

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that neither the applicant nor its principals:

• Is presently excluded or disqualified;

• Has been convicted within the preceding three years of any of the offenses listed in 2 CFR § 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period;

• Is presently indicted for, or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with, commission or any of the offenses listed in 2 CFR § 180.800(a); or

• Has had one or more public transactions (federal, state, or local) terminated within the preceding three years for cause or default.

Certification – Drug Free Workplace

This certification is required by section 184 of the NCSA (42 U.S.C. 12644), sections 5150-5160 of the Drug-Free Workplace Act of 1988 (41 U.S.C. 8101-8106), and CNCS’s implementing regulations at 2 CFR Part 2245, Subpart B.  Under these authorities, grantees mustcertify, prior to award, that they will make a good faith effort, on a continuing basis, to maintain a drug-free workplace. 

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that the applicant will provide a drug-free workplace by:

A. Publishing a drug-free workplace statement that:

1. Notifies employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee’s workplace;

2. Specifies the actions that the grantee will take against employees for violating that prohibition; and

3. Informs employees that, as a condition of employment under any award, each employee will abide by the terms of the statement and notify the grantee in writing if the employee is convicted for a violation of a criminal drug statute occurring in the workplace within five days of the conviction;

B. Requiring that a copy of the statement described in paragraph (A) be given to each employee who will be engaged in the performance of any federal award;

C. Establishing a drug-free awareness program to inform employees about:

1. The dangers of drug abuse in the workplace;

2. The grantee’s policy of maintaining a drug-free workplace;

3. Any available drug counseling, rehabilitation, and employee assistance programs; and

4. The penalties that the grantee may impose upon them for drug abuse violations occurring in the workplace;

D. Providing CNCS, as well as any other federal agency on whose award a convicted employee was working, with written notification within 10 calendar days of learning that an employee has been convicted of a drug violation in the workplace;

E. Taking one of the following actions within 30 calendar days of learning that an employee has been convicted of a drug violation in the workplace:

1. Taking appropriate personnel action against the employee, up to and including termination; or

2. Requiring that the employee participate satisfactorily in a drug abuse assistance or rehabilitation program approved for these purposes by a federal, state, or local health, law enforcement, or other appropriate agency;

F. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (A) through (E).

Certification – Lobbying Activities

As required by 31 U.S.C. 1352, as the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that:

• No federal appropriated funds have been paid or will be paid, by or on behalf of the applicant, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer of Congress in connection with the awarding of any federal contract, the making of any federal loan, the entering into of any cooperative agreement, or modification of any federal contract, grant, loan, or cooperative agreement;

• If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the applicant will submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions;

• The applicant will require that the language of this certification be included in the award documents for all subcontracts at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients will certify and disclose accordingly.

Certification - Grant Review Process (State Commissions Only)

I certify that in conducting our review process, we have ensured compliance with the National and Community Service Act of 1990, and all state laws and conflict of interest rules.

Certification – Federal Tax Liability

I certify that, if the applicant is a corporation,

1. The corporation does not have any unpaid federal tax liability—

1. That has been assessed,

2. For which all judicial and administrative remedies have been exhausted or have lapsed, and

3. That is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, or

2. A federal agency has considered suspension or debarment of the corporation based on the unpaid tax liability and has made a determination that this further action is not necessary to protect the interests of the government.

Certification – Felony Criminal Conviction under Federal Law

I certify that, if the applicant is a corporation,

1. The corporation has not been convicted of a felony criminal violation under any federal law within the preceding 24 months, or

2. A federal agency has considered suspension or debarment of the corporation based on that conviction and has made a determination that this further action is not necessary to protect the interests of the government

Certifications – Subgrants and Lower Tiered Nonprocurement Transactions with Excluded or Disqualified Persons (NCSA Subtitle C and Social Innovation Fund applicants only)

Definitions

The terms “debarment,” “suspension,” “excluded,” “disqualified,” “ineligible,” “participant,” “person,” “principal,” “proposal,” and “voluntarily excluded” as used in this document have the meanings set out in 2 CFR Part 180, Subpart I, “Definitions.” A transaction shall be considered a “covered transaction” if it meets the definition in 2 CFR Part 180 Subpart B, “What Is a covered transaction?”

Assurance requirement for subgrant and other lower tier nonprocurement agreements

You agree by submitting this proposal that, if we approve your application, in accordance with 2 CFR Part 180 Subpart C, you shall not enter into any lower tier nonprocurement covered transaction with a person without verifying that the person is not excluded or disqualified unless authorized by CNCS.

Assurance inclusion in subgrant agreements

You agree by submitting this proposal that you will obtain an assurance from prospective participants in all lower tier covered nonprocurement transactions and in all solicitations for lower tier covered nonprocurement transactions that the participants will comply with the provisions of 2 CFR Part 180 subparts A, B, C and I.

Notice of error in certification or assurance

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

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