Form 1122-0029 PREA Worksheet

Certification with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended and the Prison Rape Elimination Act for the STOPFormula Grant Program

PREAFORM

Certification with the Statutory Eligibility Requirements of the Violence Against Women Act as Amended and the Prison Rape Elimination Act for the STOPFormula Grant Program

OMB: 1122-0029

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Prison Rape Elimination ACT (PREA
Excel Workbook Guide 2015

OMB Number: 1122-0029
Expiration Date: 07/31/2017

Prison Rape Elimination Act (PREA)
Workbook Instructions
Please read the
Prison
As a result of VAWA 2013 and the penalty provision of the Prison
RapeRape
Elimination Act (PREA),
ACT compliance has the
states are required to certify compliance with PREA. A state thatElimination
cannot certify
(PREA) Workbook
option of forfeiting 5 percent (5 %) of covered funds* (95 percent
of the STOP award because the
Instructions
court set-aside is excluded) or executing an assurance that 5 percent
(5%) of
covered funds* will be
completely
before
continuing.
used towards coming into compliance with PREA.

R
Regardless of the option chosen for FY 2015, a state that elected either option 1 or option 2 in FY
2014 will receive a proportional amount of the funds forefited by states that elected option 3 in FY
2014. States that elected option 3 in FY 2014 are not eligible for any portion of the FY 2014
forefitted sums regardless of their FY 2015 election and will receive only their FY 2015 STOP
allocation less any PREA penalty. The options are prepopulated with each states FY 2015
allocation, as well as their portion of the FY 2014 forfeited funds if applicable. If you believe your
assessment is incorrect, please contact OVW as soon as possible.

Option 1

Option 2

Option 3

Please use this worksheet if your state confirms compliance with PREA. At the
bottom of the form, the State STOP Administrator should print his/her name, sign,
and date, in the designated area.
Please use this worksheet to view the 2015 reallocation and indicate which
actions will be completed to be compliant with PREA. At the bottom of the form,
the State STOP Administrator should print his/her name, sign, and date, in the
designated area.
Please use this worksheet to view the penalty for non-compliance with PREA. At
the bottom of the form, the State STOP Administrator should print his/her name,
sign, and date, in the designated area.

*Covered funds refers to the amount the State will be awarded after the five percent court set-aside has been deducted.

Public Reporting Burden Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it
displays a currently valid OMB control number. We try to create forms that are accurate, can be easily understood, and which impose the least possible burden on you to
provide us with information. The estimated time to complete and file this form is between two and 60 minutes per form. If you have comments regarding the accuracy of this
estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 145 N Street, NE, 10th Floor,
Washington, DC 20530.

OMB Number: 1122-0029
Expiration Date: 07/31/2017

Prison Rape Elimination Act Worksheet: Option 1
As a result of VAWA 2013 and the penalty provision of the Prison Rape Elimination Act (PREA), states are required to certify compliance
Select
a state
fromworksheet only if your state can confirm compliance with PREA. Select your state from the drop-down menu,
with PREA.
Please
use this
the
drop-down
print your name, sign, and date the form. Please note: All yellow cells require user input. If your state cannot confirm compliance,
Print STOP
menu
please use
either worksheet option 2 or 3. A state that cannot certify compliance has the option
of forfeiting 5 percent of covered
Administrators
funds* (96.75 percent of the STOP award because the court set-aside is excluded) or executingName
an assurance that 5 percent of covered
funds* will be used towards coming into compliance with PREA.
The State of (Please select a state.) is in compliance with the Prison Rape Elimination Act (PREA).
State STOP Administrator Printed Name: ______________________________________________________________________________
State STOP Administrator Signature: ____________________________________ Date: ________________________________________

*Covered funds refers to the amount the State will be awarded after the five percent court set-aside has been deducted.

Date
Public Reporting Burden Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms
that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated time to complete and file this form is between two and 60 minutes per form. If you have
comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 145 N Street, NE, 10th Floor, Washington, DC 20530.

Sign STOP
Administrator's
Name

Prison Rape Elimination Act (PREA) Worksheet: Option 2
Select a state from
the drop-down
menu

The purpose of this form is to guide states when confirming compliance with PREA. As a result of VAWA 2013 and the penalty provision of the Prison Rape Elimination Act (PREA), states are required to certify compliance with
PREA. States that cannot certify compliance can execute an assurance that 5 percent of covered funds* will be used towards coming into compliance with PREA. The worksheet below should be used if your state intends to use
STOP funds towards coming into PREA compliance. Please use this worksheet to view the reallocation and indicate which actions, if any, will be completed to be in compliance with PREA. Please note: All yellow cells require user
input.
STEP 1
Please select your State from the drop-down menu and then proceed to STEP 2.

Insert the
description of how
Please select a state.
your state will
STEP 2
become
compliant
Please identify steps that will be taken to be compliant with PREA. Please check
the box if the activity
will use STOP funds to become compliant with PREA. Then, please proceed to STEP 3.
and check the
[Insert text here.]
activities that will
STOP funding will be used to
[Insert text here.]
accomplish these activities to
enable your state
come into compliance with
[Insert text here.]
to establish
PREA:
compliance
[Insert text here.]

STEP 3
1) In the appropriate category in the column State Determination: Distribution of PREA Reallocation , enter the amount that will be expended to come into compliance with PREA. Please note: The category must match the
activities to be completed to be compliant with PREA. For example, if the State will hire additional police officers to be compliant with PREA, then the State must specify the amount in the Law Enforcement category or the
discretionary category. The amount(s) entered in the categories (yellow cells) cannot exceed the PREA reallocation amount.
2) States may allocate up to 10 percent of each of the STOP allocations to be used for administration of the STOP award. Please enter a percentage, not to exceed 10 percent, in each allocation (Administrative Costs (%) Per SetAside column) to be used to administer the STOP award. For further information, please refer to page nine of the STOP Formula FAQs found at http://www.ovw.usdoj.gov/docs/stop-formula-faq.pdf.

Allocation
Court Set-Aside (5%)
Victim Services (30%)
Law Enforcement (25%)
Prosecution (25%)
Discretionary (15%)

Insert the
percentage % of
allocations for
FY 2014
PREA
Administrative
costs
FY 2015 Allocation Amount
Compliance
that will be Redistribution
deducted from each
#N/A
#N/A
category
(up to#N/A
10%
#N/A
#N/A allocation) #N/A
per

TOTAL

#N/A
#N/A
#N/A

#N/A
#N/A
#N/A

#N/A

#N/A

Print STOP
Administrators
Name

0%
0%
0%
0%
0%
Maximum (10%)
#N/A

TOTAL
Administrative
Costs ($)
#N/A
#N/A
#N/A
#N/A
#N/A
#N/A

PREA Eligible Allocation
Amounts AFTER
Administrative Costs
(excluding 2014 PREA
Compliance Redistribution)

#N/A
#N/A
#N/A
#N/A

$
$
$
$
$

-

#N/A
#N/A
#N/A
#N/A
#N/A

#N/A

$

-

#N/A

$

#N/A

-

Note: The PREA penalty and PREA reallocation boxes must equal
#N/A
and be green in order to move to Step 5

Required PREA Allocation #N/A

Please select a state.

The State of

Administrative Costs
(%)
Per Set-Aside

Insert the
State
percentage
fromAfter
STOP %
Allocation
Determination:
Deduction
which the PREAof PREA
Distribution of
Compliance Redistribution
PREA
penalty and
willAdministrative
be
Costs
Reallocation
deducted

STEP 4
will use STOP funds to come into compliance with PREA.

State STOP Administrator Printed Name: ___________________________________________________________
State STOP Administrator Signature: _______________________________________________________ Date: ________________________________________
*Covered funds refers to the amount the State will be awarded after the five percent court set-aside has been deducted.
Public Reporting Burden Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated time to
complete and file this form is between two and 60 minutes per form. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 145 N Street, NE, 10th Floor, Washington, DC 20530.

Sign

Date

OMB Number: 1122-0029
Expiration Date: 07/31/2017

Prison Rape Elimination Act (PREA) Worksheet: Option 3
The purpose of this form is to guide States when confirming compliance with PREA. As a result of VAWA 2013 and the penalty provision of the Prison Rape Elimination Act (PREA), States
are required to certify compliance with PREA. If States cannot certify compliance, they have theSelect
option of forfeiting
a state5 percent
from of covered funds* (95 percent of the STOP award because
the court set-aside is excluded). Please use this worksheet to view the penalty for non-compliance
PREA. At the bottom of the form, please print your name, sign, and date the form.
thewithdrop-down
Please note: All yellow cells require user input.

menu

STEP 1
Please select your State from the drop-down menu and then proceed to STEP 2.
Please select a state.
STEP 2
1) The State will be assessed a 5 percent penalty for non-compliance with PREA. This five percent penalty will be deducted from the State's covered funds.* The State cannot choose from
which category of the allocation that amount is deducted.
2) States may allocate up to 10 percent of each of the STOP allocations to be used for administration of the STOP award. Please enter a percentage, not to exceed 10 percent, in each
allocation (yellow cells) to be used to administer the STOP award. For further information, please refer to page nine of the STOP Formula FAQs found at
http://www.ovw.usdoj.gov/docs/stop-formula-faq.pdf . Then, please proceed to STEP 3.
Insert the
STOP Allocation After
FY 2014 PREA
PREA Penalty
percentage
%
from
FY 2015 Allocation
2015 PREA Penalty
Total After PREA
Administrative Costs Total Administrative
Compliance
Administrative Costs, and
whichCosts
allocation
(or
Amount
(5%)
Penalty**
(%)
($)
Redistribution
2014 Compliance
combination of
Redistribution
Allocation
#N/A
#N/A
#N/A
#N/A
allocations) the
Court Set-Aside (5%)
#N/A
#N/A
$
#N/A
0%
#N/A
#N/A
administrative
costs #N/A
Victim Services (30%)
#N/A
#N/A
#N/A
#N/A
0%
#N/A
deducted
Law Enforcement (25%)
#N/A
#N/A
#N/A
#N/A
0%will be #N/A
#N/A
Prosecution (25%)
#N/A
#N/A
#N/A
#N/A
0%from each
#N/A category
#N/A
Discretionary (15%)
#N/A
#N/A
#N/A
#N/A
0%
#N/A
#N/A
Maximum 10% (up to 10% per
Print STOP
TOTAL
#N/A
#N/A
#N/A
#N/A
#N/A
#N/A
#N/A
allocation)

Administrators
Name

The State of

Please select a state.

STEP 3
is not in compliance with PREA and accepts the five percent PREA penalty.

State STOP Administrator Printed Name: _________________________________________________________________________
State STOP Administrator Signature: _____________________________________________________________________________ Date: ________________________
*Covered funds refers to the amount the State will be awarded after the five percent court set-aside has been deducted. **Total rounded.
Public Reporting Burden Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms that are accurate, can be easily
understood, and which impose the least possible burden on you to provide us with information. The estimated time to complete and file this form is between two and 60 minutes per form. If you have comments regarding the accuracy of this estimate, or suggestions for making
this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 145 N Street, NE, 10th Floor, Washington, DC 20530.


File Typeapplication/pdf
File TitlePrison Rape Elimination Act Worksheet Guide (The Step by Step Instructions)
AuthorNeville, Somelea (OVW)
File Modified2015-10-30
File Created2015-08-11

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