Standard Forms

U.S. Department of Education
Supplemental Information for the SF-424
1. Project Director:
Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Address:
* Street1:
Street2:
* City:
County:
* State:

* Zip Code:

* Phone Number (give area code):

Country:
Fax Number (give area code):

* Email Address:

2. Novice Applicant:
Are you are a novice applicant as defined in the regulations in 34 CFR 75.225 (and included in the
definitions page in the attached instructions)?
Yes

No

3. Human Subjects Research:
a. Are any research activities involving human subjects planned at any time during the
proposed Project Period?
Yes

No

b. Are ALL the research activities proposed designated to be exempt from the regulations?
Yes

Provide Exemption(s) # (s):  1  2  3  4  5  6 7

No

Provide Assurance #(s), if available:

8

c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to this form
as indicated in the definitions page in the attached instructions.
OMB Number: 1894-0007
Expiration Date: 9/30/2020

U.S. DEPARTMENT OF EDUCATION
BUDGET INFORMATION NON-CONSTRUCTION PROGRAMS

OMB Control Number: 1894-0008
Expiration Date: 08/31/2020

Applicants requesting funding for only one year should complete the column under
"Project Year 1." Applicants requesting funding for multi-year grants should complete all
applicable columns. Please read all instructions before completing form.

Name of Institution/Organization

SECTION A - BUDGET SUMMARY U.S. DEPARTMENT OF EDUCATION FUNDS
Budget Categories

Project Year 1
(a)

Project Year 2
(b)

Project Year 3
(c)

Project Year 4
(d)

Project Year 5
(e)

Total
(f)

1. Personnel
2. Fringe Benefits
3. Travel
4. Equipment
5. Supplies
6. Contractual
7. Construction
8. Other
9. Total Direct Costs (lines 1-8)
10. Indirect Costs
*Enter Rate Applied
11. Training Stipends
12. Total Costs (lines 9-11)
*Indirect Cost Information (To Be Completed by Your Business Office):
If you are requesting reimbursement for indirect costs on line 10, please answer the following questions:
(1) Do you have an Indirect Cost Rate Agreement approved by the Federal government? ____Yes ____No.
(2) If yes, please provide the following information:
Period Covered by the Indirect Cost Rate Agreement: From: ___/___/______ To: ___/___/______ (mm/dd/yyyy)
Approving Federal agency: ____ED ____Other (please specify): __________________________ The Indirect Cost Rate is _________%
(3) If this is your first Federal grant, and you do not have an approved indirect cost rate agreement, are not a State, Local government or Indian Tribe, and are not funded
under a training rate program or a restricted rate program, do you want to use the de minimis rate of 10% of MTDC? ____Yes ____No. If yes, you must comply
with the requirements of 2 CFR § 200.414(f).
(4) If you do not have an approved indirect cost rate agreement, do you want to use the temporary rate of 10% of budgeted salaries and wages? ____Yes ____No. If
yes, you must submit a proposed indirect cost rate agreement within 90 days after the date your grant is awarded, as required by 34 CFR § 75.560.
(5) For Restricted Rate Programs (check one) -- Are you using a restricted indirect cost rate that:___ Is included in your approved Indirect Cost Rate Agreement?
Or ___ Complies with 34 CFR 76.564(c)(2)? The Restricted Indirect Cost Rate is _________%
(6) For Training Rate Programs (check one) -- Are you using a rate that: ____Is based on the training rate of 8 percent of MTDC (See EDGAR § 75.562(c)(4))? Or
____Is included in your approved Indirect Cost Rate Agreement, because it is lower than the training rate of 8 percent of MTDC (See EDGAR § 75.562(c)(4)).
ED 524

Name of Institution/Organization

Applicants requesting funding for only one year should complete the column under
"Project Year 1." Applicants requesting funding for multi-year grants should complete all
applicable columns. Please read all instructions before completing form.
SECTION B - BUDGET SUMMARY
NON-FEDERAL FUNDS

Budget Categories

Project Year 1
(a)

Project Year 2
(b)

Project Year 3
(c)

Project Year 4
(d)

1. Personnel
2. Fringe Benefits
3. Travel
4. Equipment
5. Supplies
6. Contractual
7. Construction
8. Other
9. Total Direct Costs
(Lines 1-8)
10. Indirect Costs
11. Training Stipends
12. Total Costs
(Lines 9-11)

SECTION C – BUDGET NARRATIVE (see instructions)
ED 524

Project Year 5
(e)

Total
(f)

Disclosure of Lobbying Activities

Approved by OMB
0348-0046

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:
a. contract
____ b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance

4.

6.

2.

Status of Federal Action:
a. bid/offer/application
_____ b. initial award
c. post-award

Name and Address of Reporting Entity:
____ Prime
_____ Subawardee
Tier______, if Known:

Congressional District, if known:
Federal Department/Agency:

5.

7.

3.

Report Type:
a. initial filing
_____ b. material change

For material change only:
Year _______ quarter _______
Date of last report___________

If Reporting Entity in No. 4 is Subawardee,
Enter Name and Address of Prime:

Congressional District, if known:
Federal Program Name/Description:

CFDA Number, if applicable: ____________
8.

Federal Action Number, if known:

10. a. Name and Address of Lobbying Registrant
(if individual, last name, first name, MI):

11. Information requested through this form is authorized by
title 31 U.S.C. section 1352. This disclosure of lobbying
activities is a material representation of fact 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 reported
to the Congress semi-annually and 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.

Federal Use Only

9.

Award Amount, if known:
$

b. Individuals Performing Services (including address if
different from No. 10a)
(last name, first name, MI):

Signature: __________________________________
Print Name: _____
Title: _____
Telephone No.: ____________ Date: _______
Authorized for Local Reproduction
Standard Form - LLL (Rev. 7-97)

OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 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 (0348-0040), Washington, DC 20503

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note:

Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding
agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case,
you will be notified.

As the duly authorized representative of the applicant I certify that the applicant:
1.

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 cost) to ensure proper planning, management, and
completion of the project described in this application.

2.

Will give the awarding agency, 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.

3.

Will establish safeguards to prohibit employees from using
their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest,
or personal gain.

4.

Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.

5.

Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. ∋∋4728-4763) relating to prescribed
standards for merit systems for programs funded under one of
the 19 statutes or regulations specified in Appendix A of
OPM's Standards for a Merit System of Personnel
Administration (5 C.F.R. 900, Subpart F).

6.

Prevention, Treatment and Rehabilitation Act of 1970 (P.L.
91-616), as amended, relating to nondiscrimination on the
basis of alcohol abuse or alcoholism; (g) ∋∋ 523 and 527 of
the Public Health Service Act of 1912 (42 U.S.C. ∋∋ 290 dd-3
and 290 ee 3), as amended, relating to confidentiality of
alcohol and drug abuse patient records; (h) 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 housing; (i) any other nondiscrimination
provisions in the specific statute(s) under which application
for Federal assistance is being made; and (j) the requirements
of any other nondiscrimination statute(s) which may apply to
the application.
7.

Will comply, or has already complied, with the requirements
of Titles II and III of the uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1970 (P.L. 91-646)
which provide for fair and equitable treatment of persons
displaced or whose property is acquired as a result of Federal
or federally assisted programs. These requirements apply to
all interests in real property acquired for project purposes
regardless of Federal participation in purchases.

8.

Will comply, as applicable, 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 comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which
prohibits discrimination on the basis of race, color or national
origin; (b) 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; (c) Section 504
of the Rehabilitation Act of 1973, as amended (29 U.S.C.
∋794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. ∋∋ 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office
and Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug abuse; (f)
the Comprehensive Alcohol Abuse and Alcoholism

Previous Edition Usable

Authorized for Local Reproduction

Standard Form 424B (Rev. 7-97)
Prescribed by OMB Circular A-102

9.

Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. ∋∋276a to 276a-7), the Copeland Act
(40 U.S.C. ∋276c and 18 U.S.C. ∋∋874) and the Contract
Work Hours and Safety Standards Act (40 U.S.C. ∋∋ 327333), regarding labor standards for federally assisted
construction subagreements.

10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. ∋∋1451 et seq.); (f) conformity of Federal
actions to State (Clear Air) Implementation Plans under
Section 176(c) of the Clear Air Act of 1955, as amended (42
U.S.C. ∋∋7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act
of 1974, as amended, (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of
1973, as amended, (P.L. 93-205).

12

Will comply with the Wild and Scenic Rivers Act of 1968
(16 U.S.C. ∋∋1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers
system.

13. Will assist the awarding agency 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-1 et
seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. ∋∋2131 et seq.)
pertaining to the care, handling, and treatment of warm
blooded animals held for research, teaching, or other
activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention
Act (42 U.S.C. ∋∋4801 et seq.) which prohibits the use of
lead- based paint in construction or rehabilitation of
residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit Act
Amendments of 1996 and OMB Circular No. A-133,
ΑAudits of States, Local Governments, and Non-Profit
Organizations.≅
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations and policies
governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

APPLICANT ORGANIZATION

TITLE

DATE SUBMITTED

Standard Form 424B (Rev. 7-97) Back

CERTIFICATION REGARDING LOBBYING (80-0013)
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with
the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification
is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that:
If any 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 commitment providing for the United States to insure or
guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying
Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure.

* APPLICANT’S ORGANIZATION

* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Prefix:
* Last Name:

* First Name:

Middle Name:
Suffix:

* Title:

* SIGNATURE:

* DATE: