Standard forms

OMB Number: 4040-0004

View Burden Statement

Expiration Date: 12/31/2022

Application for Federal Assistance SF-424
* 1. Type of Submission:

* 2. Type of Application:

Preapplication

New

Application

Continuation

Changed/Corrected Application

Revision

* 3. Date Received:

* If Revision, select appropriate letter(s):

* Other (Specify):

4. Applicant Identifier:

5a. Federal Entity Identifier:

5b. Federal Award Identifier:

State Use Only:
6. Date Received by State:

7. State Application Identifier:

8. APPLICANT INFORMATION:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN):

* c. Organizational DUNS:

d. Address:
* Street1:
Street2:
* City:
County/Parish:
* State:
Province:
* Country:

USA: UNITED STATES

* Zip / Postal Code:
e. Organizational Unit:
Department Name:

Division Name:

f. Name and contact information of person to be contacted on matters involving this application:
Prefix:

* First Name:

Middle Name:
* Last
Name:
Suffix:
Title:
Organizational Affiliation:

* Telephone Number:
* Email:

Fax Number:

Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

* Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

Add Attachment
* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

Add Attachments

Delete Attachments

View Attachments

Delete Attachment

View Attachment

Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant

* b. Program/Project

Attach an additional list of Program/Project Congressional Districts if needed.

Add Attachment

Delete Attachment

View Attachment

17. Proposed Project:
* a. Start Date:

* b. End Date:

18. Estimated Funding ($):
* a. Federal
* b. Applicant
* c. State
* d. Local
* e. Other
* f. Program Income
* g. TOTAL
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
.

a. This application was made available to the State under the Executive Order 12372 Process for review on
b. Program is subject to E.O. 12372 but has not been selected by the State for review.
c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

Yes

No

If "Yes", provide explanation and attach
Add Attachment

Delete Attachment

View Attachment

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** I AGREE
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix:

* First Name:

Middle Name:
* Last Name:
Suffix:
* Title:
* Telephone Number:

Fax Number:

* Email:
* Signature of Authorized Representative:

* Date Signed:

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)

OMB Control No. 1894-0005 (Exp 06/30/2023)

NOTICE TO ALL APPLICANTS
The purpose of this enclosure is to inform you about
the following provision in the Department of
Education's General Education Provisions Act
(GEPA) that applies to applicants for new grant
awards under Department programs. This provision
is Section 427 of GEPA, enacted as part of the
Improving America's Schools Act of 1994 (Public
Law (P.L.) 103-382).
To Whom Does This Provision Apply?
Section 427 of GEPA affects applicants for new grant
awards under this program. ALL APPLICANTS
FOR NEW AWARDS MUST INCLUDE
INFORMATION IN THEIR APPLICATIONS
TO ADDRESS THIS NEW PROVISION IN
ORDER TO RECEIVE FUNDING UNDER THIS
PROGRAM.
(If this program is a State-formula grant program, a
State needs to provide this description only for
projects or activities that it carries out with funds
reserved for State-level uses. In addition, local
school districts or other eligible applicants that apply
to the State for funding need to provide this
description in their applications to the State for
funding. The State would be responsible for ensuring
that the school district or other local entity has
submitted a sufficient section 427 statement as
described below.)
What Does This Provision Require?
Section 427 requires each applicant for funds (other
than an individual person) to include in its
application a description of the steps the applicant
proposes to take to ensure equitable access to, and
participation in, its Federally-assisted program for
students, teachers, and other program beneficiaries
with special needs. This provision allows applicants
discretion in developing the required description.
The statute highlights six types of barriers that can
impede equitable access or participation: gender,
race, national origin, color, disability, or age. Based
on local circumstances, you should determine
whether these or other barriers may prevent your
students, teachers, etc. from such access or
participation in, the Federally-funded project or
activity. The description in your application of steps
to be taken to overcome these barriers need not be
lengthy; you may provide a clear and succinct
description of how you plan to address those barriers
that are applicable to your circumstances.
In
addition, the information may be provided in a single

narrative, or, if appropriate, may be discussed in
connection with related topics in the application.
Section 427 is not intended to duplicate the
requirements of civil rights statutes, but rather to
ensure that, in designing their projects, applicants for
Federal funds address equity concerns that may affect
the ability of certain potential beneficiaries to fully
participate in the project and to achieve to high
standards. Consistent with program requirements and
its approved application, an applicant may use the
Federal funds awarded to it to eliminate barriers it
identifies.
What are Examples of How an Applicant Might
Satisfy the Requirement of This Provision?
The following examples may help illustrate how an
applicant may comply with Section 427.
(1) An applicant that proposes to carry out an
adult literacy project serving, among others,
adults with limited English proficiency, might
describe in its application how it intends to
distribute a brochure about the proposed project
to such potential participants in their native
language.
(2) An applicant that proposes to develop
instructional materials for classroom use might
describe how it will make the materials available
on audio tape or in braille for students who are
blind.
(3) An applicant that proposes to carry out a
model science program for secondary students
and is concerned that girls may be less likely
than boys to enroll in the course, might indicate
how it intends to conduct "outreach" efforts to
girls, to encourage their enrollment.
(4) An applicant that proposes a project to
increase school safety might describe the special
efforts it will take to address concern of lesbian,
gay, bisexual, and transgender students, and
efforts to reach out to and involve the families of
LGBT students
We recognize that many applicants may already be
implementing effective steps to ensure equity of
access and participation in their grant programs, and
we appreciate your cooperation in responding to the
requirements of this provision.

Estimated Burden Statement for GEPA Requirements

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid OMB control number.
Public reporting burden for this
collection of information is estimated to average 1.5 hours 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. The obligation to respond to this collection is required to obtain or
retain benefit (Public Law 103-382. Send comments regarding the burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the U.S. Department of Education,
400 Maryland Ave., SW, Washington, DC 20210-4537 or email [email protected] and reference the OMB Control Number
1894-0005.

CERTIFICATION REGARDING LOBBYING
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 $10,00 0 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 subjec t 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:

* First Name:

Middle Name:
Suffix:

* Last Name:
* Title:
* SIGNATURE:

* DATE:

DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352

OMB Number: 4040-0013
Expiration Date: 02/28/2022

Review Public Burden Disclosure Statement

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

d. loan
e. loan guarantee
f. loan insurance

4. Name and Address of Reporting Entity:
Prime

SubAwardee

* Name
* Street 1

Street 2

* City

State

Zip

Congressional District, if known:

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

6. * Federal Department/Agency:

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:
Prefix

Middle Name

* First Name

* Last Name

Suffix

* Street 1

Street 2

* City

State

Zip

b. Individual Performing Services (including address if different from No. 10a)
Prefix

Middle Name

* First Name

* Last Name

Suffix

* Street 1

Street 2

* City

State

Zip

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 the 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.

* Signature:
*Name:

Prefix

* First Name

Middle Name

* Last Name

Title:

Federal Use Only:

Suffix

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.

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. §§16811683, 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 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 ee3), 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 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.

Previous Edition Usable

Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction

Prescribed by OMB Circular A-102

9.

10.

11.

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.
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.
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 (Clean Air) Implementation Plans
under Section 176(c) of the Clean 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. 93205).

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

APPLICANT ORGANIZATION

12.

Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 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,
"Audits 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.

TITLE

DATE SUBMITTED

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