HBCU Masters Application

U.S. DEPARTMENT OF EDUCATION

OFFICE OF POSTSECONDARY EDUCATION

WASHINGTON, DC 20202

Fiscal Year 20___

APPLICATION FOR GRANTS

HISTORICALLY BLACK COLLEGES AND UNIVERSITIES MASTER’S DEGREE PROGRAM

CFDA No. 84.382G

CLOSING DATE: TBD

OMB No. 1840-0806

Expiration Date: ___/___/2020

PAPERWORK BURDEN STATEMENT

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 17 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 (under 34 CFR §608.3) to obtain or retain benefit (Section 322(2) of the Higher Education Act of 1965, as amended (HEA)). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to regulations.gov during the public comment period for this collection of information.  If you have specific questions about the form, instrument, or survey, please contact Ms. Sheryl Wilson, Director, Historically Black Colleges and Universities Division, Office of Postsecondary Education, 400 Maryland Avenue, SW, Washington, D.C. 20202.

TABLE OF CONTENTS

Dear Applicant Letter 1

Competition Highlights 2

Overview of Program and Requirements 4

Statute 9

Instructions for Completing the Application

Part I: Project Plan 13

Profile Form and Program Assurances 15

Goals and Objectives Form 17

Part II: Formula Elements 18

Executive Order 12372: Intergovernmental Review 20

GEPA 21

GPRA 22

G5 e-Application Submission Procedures and Tips for Applicants 25

Instructions for the SF 424 29

Instructions for Supplement to SF 424 31

Definitions for Supplement to SF 424 32

Instructions for ED 524 35

Instructions for Completion of SF-LLL 38

U.S. DEPARTMENT OF EDUCATION

OFFICE OF POSTSECONDARY EDUCATION

WASHINGTON, DC 20202

Dear Applicant:

Thank you for your interest in applying for a grant in fiscal year (FY) 20___ for new awards under the Historically Black Colleges and Universities Master’s Degree (HBCU-M) Program. Funding for this program is provided under Title VII, Part A, Subpart 4, Section 723 of the Higher Education Act of 1965, as amended (HEA), for grant awards to eligible institutions making a substantial contribution to graduate education opportunities at the master’s degree level in the following areas: mathematics; engineering; the physical or natural sciences; computer science; information technology; nursing; allied health; or other scientific disciplines in which African Americans are underrepresented. The program provides grants for up to six years to establish or strengthen qualified master’s degree programs in these fields.

Institutions of higher education eligible to apply for and receive grants under the

HBCU-M Program are designated in the statute. A copy of the statute for this program and all instructions and forms necessary to apply for grants are included in this application package.

The entire application package, including all standard forms and assurances, must be emailed by _______p.m. Eastern standard time on ______, to the HBCU Master’s Degree mailbox at [email protected].

If you have any questions or require additional information, please contact TBD via email at ______ed.gov or by phone at (202) 453-_____.

I appreciate your interest in the HBCU-M Program and look forward to receiving your application.

Sincerely,

Sheryl Wilson

Director,

HBCU and PBI Division

Institutional Service

COMPETITION HIGHLIGHTS

1. HBCU-M institutions awarded in FY ____ may not receive any grants from programs listed below in the same fiscal year. In accordance with the Section 723 of the HEA of 1965, no institution that is eligible for and receives a grant under Section 326 (Historically Black Graduate Institutions Program), Section 512 (Promoting Postbaccalaureate Opportunities for Hispanic Americans Program) or Section 724 (Predominantly Black Institutions Graduate Program) for a fiscal year shall be eligible to apply for or receive funds under this program for that same fiscal year.

2. Institutions eligible for the HBCU-M grants are listed in the statute and include: Albany State University; Alcorn State University; Claflin University; Coppin State University; Elizabeth City State University; Fayetteville State University; Fisk University; Fort Valley State University; Grambling State University; Kentucky State University; Mississippi Valley State University; Savannah State University; South Carolina State University; University of Arkansas, Pine Bluff; Virginia State University; West Virginia State University; Wilberforce University; and Winston-Salem State University.

3. Eligible HBCU-M institutions must complete the Goals and Objectives Form, the Profile Form and Program Assurances, and the standard ED Forms and narrative portions of the application.

4. The Funding Formula for the HBCU Master’s Program is as follows:

Any amount appropriated for these programs during any fiscal year in excess of $9,000,000 shall be made available to each of the eligible institutions pursuant to a formula developed by the Secretary that uses the following elements:

• The ability of the institution to match Federal funds with non-Federal funds;

• The number of students enrolled in the qualified master’s degree program at the eligible institution in the previous academic year;

• The average cost of attendance per student, for all full-time students enrolled in the qualified master’s degree program at the institution;

• The number of students in the previous year who received a degree in the qualified master’s degree program at each institution; and

• The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this program to the total number of African Americans receiving master’s degrees in the disciplines related to the programs for the previous year.

5. Section 723 also states, “each eligible institution will receive a grant of no less than $500,000 for any fiscal year, unless the amount appropriated is not sufficient to pay the minimum grant awards to all eligible institutions; in this event, the amount paid to each eligible institution will be ratably reduced.”

6. Based upon the above stated statutory language, Part II -The Formula Elements Sheet is required to be completed. The FY 20__ appropriation is above the statutory level of $9,000,000, thus requiring formula data to be collected.

7. The consolidated application package must be emailed to the HBCU Master’s mailbox at [email protected] by ________ Eastern standard time on TBD.

HISTORICALLY BLACK COLLEGES AND UNIVERSITIES GRADUATE PROGRAM LEGISLATION

AUTHORIZING LEGISLATION

Higher Education Act of 1965 as amended (HEA), Title VII, Subpart 4, Section 723.

Applicable Regulations:

Education Department Administrative Regulations (EDGAR), Parts 74, 75, 77, 79, 81, 82, 84, 85, 86, 97, 98 and 99.

e - CFR - Part 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.

1. OVERVIEW OF PROGRAM

Purpose:

The HBCU Master’s Degree Program makes grant awards to eligible institutions determined by the Secretary to be making a substantial contribution to graduate education opportunities at the master’s level in the following areas: mathematics; engineering; the physical or natural sciences; computer science; information technology; nursing; allied health; or other scientific disciplines in which African Americans are underrepresented. The program provides grants for up to six years to establish or strengthen qualified master’s degree programs in these fields at eligible institutions.

Eligibility:

Institutions eligible for grants are listed in the statute and include: Albany State University; Alcorn State University; Claflin University; Coppin State University; Elizabeth City State University; Fayetteville State University; Fisk University; Fort Valley State University; Grambling State University; Kentucky State University; Mississippi Valley State University; Savannah State University; South Carolina State University; University of Arkansas, Pine Bluff; Virginia State University; West Virginia State University; Wilberforce University; and Winston-Salem State University.

Authorized Activities:

Grant funds may be used for the following activities:

1. Purchase, rental, or lease of scientific or laboratory equipment for educational purposes, including instructional and research purposes;

2. Construction, maintenance, renovation, and improvement in classroom, library, laboratory, and other instructional facilities, including purchase or rental of telecommunications program materials;

3. Purchase of library books, periodicals, technical and other scientific journals, microfilm, microfiche, and other educational materials, including telecommunications program materials;

4. Scholarships, fellowships, and other financial assistance for needy graduate students to permit the enrollment of the students in, and completion of, a masters degree in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented;

5. Establishing or improving a development office to strengthen and increase contributions from alumni and the private sector;

6. Assisting in the establishment or maintenance of an institutional endowment to facilitate financial independence pursuant to Section 331 of the HEA;

7. Funds and administrative management, and the acquisition of equipment, including software, for use in strengthening funds management and management information systems;

8. Acquisition of real property that is adjacent to the campus in connection with the construction, renovation, or improvement of, or an addition to, campus facilities;

9. Education or financial information designed to improve the financial literacy and economic literacy of students or the students’ families, especially with regard to student indebtedness and student assistance programs under Title IV of the HEA;

10. Tutoring, counseling, and student service programs designed to improve academic success;

11. Faculty professional development, faculty exchanges, and faculty participation in professional conferences and meetings; and

12. Other activities proposed in the application that contribute to carrying out the purposes of the program, and are approved by the Secretary as part of the review and acceptance of the application.

II. REQUIREMENTS AND FUNDING RULES

Qualified Master’s Degree Program:

A qualified masters degree program means a master’s degree program at an eligible institution that provides a program of instruction in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented and has students enrolled in such a program of instruction at the time of application.

An institution may use no more than 10% of its grant for the development of a new qualified master’s degree program.

Institutional Choice:

The president or chancellor of the grantee institution may decide which graduate school or qualified master’s degree program will receive funds under the grant in any one fiscal year, if the allocation of funds among the schools or programs is delineated in the application.

One Grant Rule and Other Grant Programs:

In accordance with Section 723 of the HEA, institutions may not receive more than one grant in any fiscal year. No institution that is eligible for and receives a grant award under Section 326 (Historically Black Graduate Institutions Program), Section 512 (Promoting Postbaccalaureate Opportunities for Hispanic Americans program) or Section 724 (Predominantly Black Institutions Graduate Program) for a fiscal year shall be eligible to apply for or receive funds under this program for that same fiscal year.

Non-Federal Matching Funds:

If a grant in excess of $1,000,000 is made to any institution in a given fiscal year, that institution must provide assurances that 50 percent of the costs of the activities supported by the grant that exceed the $1,000,000 limit will be paid from non-Federal funds. No institution will be required to match any portion of the first $1,000,000 of that institution’s grant award for a fiscal year.

Minimum Grant Award:

Each eligible institution specified in Section 723 of the HEA will receive a grant of no less than $500,000 for any fiscal year, unless the amount appropriated is not sufficient to pay the minimum grant awards to all eligible institutions; in this event, the amount paid to each eligible institution will be ratably reduced.

In accordance with the HEA, no eligible institution that receives a grant under this program for FY 20___ and that is eligible to receive a grant in a subsequent fiscal year shall receive a grant amount in any subsequent fiscal year that is less than the grant amount received for FY 20__, unless:

• The amount appropriated is not sufficient to provide such grant amounts to all eligible institutions that received grants in FY 20__ and are eligible to receive grants in a subsequent fiscal year; or

• The institution cannot provide sufficient matching funds to meet the requirements of the program statute.

Funding Formula:

Any amount appropriated for these programs during any fiscal year in excess of $9,000,000 shall be made available to each of the eligible institutions pursuant to a formula developed by the Secretary that uses the following elements:

1. The ability of the institution to match Federal funds with non-Federal funds;

2. The number of students enrolled in the qualified master’s degree program at the eligible institution in the previous academic year;

3. The average cost of attendance per student, for all full-time students enrolled in the qualified master’s degree program at the institution;

4. The number of students in the previous year who received a degree in the qualified master’s degree program at each institution; and

5. The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this program to the total number of African Americans receiving master’s degrees in the disciplines related to the programs for the previous year.

Periodic Renewal of Grants:

Grants are awarded for up to six years. To receive continuation funding, grantee institutions must submit an Annual Performance Report, including detailed progress on funded activities and the goals and objectives cited in the original application, as well as updated data relating to formula elements. Program staff will contact grantee institutions with more details on this requirement later in the year.

Performance Indicators and Reporting:

The following performance measures were developed for this program by the U.S. Department of Education. Grantees will be required to report annually on their progress related to these measures. For more information, please see page 22 of this application, which describes the requirements of the Government Performance and Results Act (GPRA).

Enrollment

The percent change, over the period between the fall of the year the grant was issued and the fall after the end of the grant period, in the number of African American and/or low-income graduate students enrolled in the academic program(s) supported by the project.

Degrees Awarded

The percent change, over the fall semester before, in the number of African American and/or low-income students graduating in the academic program(s) supported by the project.

Time to Degree

Median time to completion of a master’s degree for African Americans and/or low-income graduate students, in the academic program(s) supported by the project during the period of the grant award.

Efficiency Measure

Cost per successful outcome: Federal cost per master’s degree earned by African American and/or low-income students, in the academic program(s) supported by the project during the period of the grant award.

Other Performance Measures

New Courses

Number of new courses, in the academic program(s) supported by the project, added as a result of this grant.

New Academic Concentrations

Number of academic concentrations, in the academic program(s) supported by the project, added as a result of this grant.

New Research Initiatives

Number of new research initiatives, in the academic program(s) supported by the project, added as a result of this grant.

Student Independent Research

Percentage of students participating in independent research, during the most recent complete academic year.

Student Research with Faculty

Percentage of students participating in research with faculty, during the most recent complete academic year.

Student Conference Presentations

Number of students presenting at conferences, during the most recent complete academic year.

Student Publications

Number of students writing for publication, during the most recent complete academic year.

Endowment Activities:

If your proposed project includes a request for endowment activities, please refer to the following:

Legislation:

HEA, Title III, Part C Endowment Challenge Grant Program

Regulations:

34 CFR Part 628, Endowment Challenge Grant Program

HIGHER EDUCATION ACT OF 1965, AS AMENDED

``SEC. 723. [NOTE: 20 USC 1136a.] MASTERS DEGREE PROGRAMS A HISTORICALLY BLACK COLLEGES AND UNIVERSITIES.

``(a) Grant Program Authorized.--

``(1) In general.--Subject to the availability of funds appropriated to carry out this section, the Secretary shall award program grants to each of the institutions listed in subsection (b)(1) that is determined by the Secretary to be making a substantial contribution to graduate education opportunities at the masters level in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines for Black Americans.

``(2) Assurance of non-federal matching funds.--No grant in excess of $1,000,000 may be made under this section unless the institution provides assurances that 50 percent of the cost of the purposes for which the grant is made will be paid from non-Federal sources, except that no institution shall be required to match any portion of the first $1,000,000 of the institution's award from the Secretary. After funds are made available to each eligible institution under the funding rules described in subsection (f), the Secretary shall distribute, on a pro rata basis, any amounts which were not so made available (by reason of the failure of an institution to comply with the matching requirements of this paragraph) among the institutions that have complied with such matching requirement.

``(3) Minimum award.--Subject to subsections (f) and (g), the amount awarded to each eligible institution listed in subsection (b)(1) for a fiscal year shall be not less than $500,000.

``(4) Duration of grants.--A grant awarded under this section shall be for a period of not more than six years, but may be periodically renewed for a period to be determined by the Secretary.

``(b) Institutional Eligibility.--

``(1) In general.--Institutions eligible for grants under subsection (a) are the following:

``(A) Albany State University.

``(B) Alcorn State University.

``(C) Claflin University.

``(D) Coppin State University.

``(E) Elizabeth City State University.

``(F) Fayetteville State University.

``(G) Fisk University.

``(H) Fort Valley State University.

``(I) Grambling State University.

``(J) Kentucky State University.

``(K) Mississippi Valley State University.

``(L) Savannah State University.

``(M) South Carolina State University.

``(N) University of Arkansas, Pine Bluff.

``(O) Virginia State University.

``(P) West Virginia State University.

``(Q) Wilberforce University.

``(R) Winston-Salem State University.

``(2) Qualified masters degree program.--

``(A) In general.--For the purposes of this section, the term `qualified masters degree program' means a masters degree program that provides a program of instruction in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented and has students enrolled in such program of instruction at the time of application for a grant under this section.

``(B) Enrollment exception.--Notwithstanding the enrollment requirement contained in subparagraph (A), an institution may use an amount equal to not more than 10 percent of the institution's grant under this section for the development of a new qualified masters degree program.

``(3) Institutional choice.--The president or chancellor of the institution may decide which graduate school or qualified masters degree program will receive funds under the grant in any one fiscal year, if the allocation of funds among the schools or programs is delineated in the application for funds submitted to the Secretary under this section.

``(4) One grant per institution.--The Secretary shall not award more than one grant under this section in any fiscal year to any institution of higher education.

``(c) Application.--An eligible institution listed in subsection (b)(1) desiring a grant under this section shall submit an application at such time, in such manner, and containing such information as the Secretary may require. The application shall--

``(1) demonstrate how the grant funds under this section will be used to improve graduate educational opportunities for Black and low-income students, and lead to greater financial independence; and

``(2) provide, in the case of applications for grants in excess of $1,000,000, the assurances required under subsection (a)(2) and specify the manner in which the eligible institution is going to pay the non-Federal share of the cost of the application.

``(d) Uses of Funds.--A grant under this section may be used for--

``(1) purchase, rental, or lease of scientific or laboratory equipment for educational purposes, including instructional and research purposes;

``(2) construction, maintenance, renovation, and improvement in classroom, library, laboratory, and other instructional facilities, including purchase or rental of telecommunications technology equipment or services;

``(3) purchase of library books, periodicals, technical and other scientific journals, microfilm, microfiche, and other educational materials, including telecommunications program materials;

``(4) scholarships, fellowships, and other financial assistance for needy graduate students to permit the enrollment of the students in, and completion of, a masters degree in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented;

``(5) establishing or improving a development office to strengthen and increase contributions from alumni and the private sector;

``(6) assisting in the establishment or maintenance of an institutional endowment to facilitate financial independence pursuant to section 331;

``(7) funds and administrative management, and the acquisition of equipment, including software, for use in strengthening funds management and management information systems;

``(8) acquisition of real property that is adjacent to the campus in connection with the construction, renovation, or improvement of, or an addition to, campus facilities;

``(9) education or financial information designed to improve the financial literacy and economic literacy of students or the students' families, especially with regard to student indebtedness and student assistance programs under title IV;

``(10) tutoring, counseling, and student service programs designed to improve academic success;

``(11) faculty professional development, faculty exchanges, and faculty participation in professional conferences and meetings; and

``(12) other activities proposed in the application submitted under subsection (c) that--

``(A) contribute to carrying out the purposes of this section; and

``(B) are approved by the Secretary as part of the review and acceptance of such application.

``(e) Interaction With Other Grant Programs.--No institution that is eligible for and receives an award under section 326, 512, or 724 for a fiscal year shall be eligible to apply for a grant, or receive grant funds, under this section for the same fiscal year.

``(f) Funding Rule.--Subject to subsection (g), of the amount appropriated to carry out this section for any fiscal year--

``(1) the first $9,000,000 (or any lesser amount appropriated) shall be available only for the purposes of making minimum grants under subsection (a)(3) to eligible institutions listed in subparagraphs (A) through (R) of subsection (b)(1), except that if the amount appropriated is not sufficient to pay the minimum grant awards to all such eligible institutions, the amount of the minimum award to each such eligible institution shall be ratably reduced;

``(2) after the application of paragraph (1), an amount shall be available for the purpose of making minimum grants under subsection (a)(3) to eligible institutions listed in subsection (b)(1) that do not receive a grant under paragraph (1), if any, except that if the amount appropriated is not sufficient to pay the minimum grant awards to all such eligible institutions, the amount of the minimum award to each such eligible institution shall be ratably reduced; and

``(3) any amount in excess of $9,000,000 shall be made available to each of the eligible institutions identified in subparagraphs (A) through (R) of subsection (b)(1), pursuant to a formula developed by the Secretary that uses the following elements:

``(A) The ability of the institution to match Federal funds with non-Federal funds.

``(B) The number of students enrolled in the qualified masters degree program at the eligible institution in the previous academic year.

``(C) The average cost of attendance per student, for all full-time students enrolled in the qualified masters degree program at such institution.

``(D) The number of students in the previous year who received a degree in the qualified masters degree program at such institution.

``(E) The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this section to the total number of African Americans receiving masters degrees in the disciplines related to the programs for the previous year.

``(g) Hold Harmless Rule.--Notwithstanding paragraphs (2) and (3) of subsection (f), no eligible institution identified in subsection (b)(1) that receives a grant under this section for fiscal year 2009 and that is eligible to receive a grant for a subsequent fiscal year shall receive a grant amount for any such subsequent fiscal year that is less than the grant amount received for fiscal year 2009, unless--

``(1) the amount appropriated is not sufficient to provide such grant amounts to all such institutions and programs that received grants under this section for such fiscal year and that are eligible to receive a grant in such subsequent fiscal year; or

``(2) the institution cannot provide sufficient matching funds to meet the requirements of this section.

``SEC. 725. [NOTE: 20 USC 1136c.] AUTHORIZATION OF APPROPRIATIONS.

``(a) Masters Degree Programs at Historically Black Colleges and

Universities.--There are authorized to be appropriated to carry out section 723 such sums as may be necessary for fiscal year 2009 and each of the five succeeding fiscal years.

INSTRUCTIONS FOR COMPLETING THE APPLICATION

An eligible institution desiring a grant under this program must submit an application that demonstrates how the grant funds will be used to improve graduate educational opportunities for Black and low-income American students, and lead to greater financial independence, and specify, if applicable, the manner in which the eligible institution will pay the non-Federal share of the costs of the activities described in the application.

Part I. Project Plan

1. Profile Page and Assurances

2. Abstract: Applicants must provide a one-page overview of the project and planned activities, demonstrating how the project will improve graduate educational opportunities for Black and low-income students, and lead to greater financial independence.

3. Narrative: Applicants must provide a project narrative, suggesting no more than 50 pages that includes the following:

• Overview: Give an overview of the institution and its qualified master’s degree program(s), citing strengths and weaknesses as well as the institution’s goals and objectives. The narrative should describe how the institution plans to use grant funds to address these goals and objectives, including detailed plans for the first year of funding as well as long-term goals for the project period of up to six years.

• Activities: Identify all of the allowable activities listed in the statute and on page 4 of this booklet for which the institution will use grant funds. Describe, in a comprehensive manner, an implementation strategy for each activity and a timetable for accomplishing these activities. Specifically identify how each funded activity will address a weakness and/or goal of the institution and its qualified master’s degree program(s), and serve the overall purpose of the program as described the statute.

• Evaluation: Please describe the strategy to be used for evaluating the effectiveness of your project. For each funded activity and the goals and objectives it addresses, please describe the specific outcomes expected and provide performance indicators that are measurable and realistic. Be sure that your evaluation plan reflects your timetable for accomplishing funded activities and provides specific outcomes and performance indicators for the first year of funding as well as for the project period as a whole.

4. Goals and Objectives: For purposes of project evaluation, please complete the Goals and Objectives Form on page 17, identifying each goal or objective to be addressed, the activity(ies) that will address it, and a measurable outcome developed to evaluate success.

5. Budget Form and Narrative: Please complete Budget Summary Form 524 and include a Budget Narrative addressing all years of the project. In the Budget Narrative, for each Budget Category, list the individual activities associated with that category, and provide a detailed breakdown of the costs associated with that activity. Please be sure to include in the Budget Narrative all activities for which you are requesting funding, placing them in the appropriate Budget Categories, and account for all funds to be spent on each activity.

HBCU MASTER’S DEGREE PROGRAM

PROFILE FORM AND PROGRAM ASSURANCES

1. Legal Name of Institution:

2. Address:

City: State: Zip:

3. Please list those qualified master’s degree programs at the applicant institution which will receive funds from this grant. (According to the statute (Section 723(b)(2)(A) of the Higher Education Act of 1965, as amended (HEA)), a qualified master’s degree program means a master’s degree program at an eligible institution that provides a program of instruction in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines in which African Americans are underrepresented and has students enrolled in such a program of instruction at the time of application.)

4. Will the institution be using grant funds under these programs to develop a new qualified master’s degree program (see Enrollment exception, Section 723 (b)(2)(B) of the HEA)?

______ Yes ______ No

If yes, please identify the new qualified master’s degree program to be developed:

If yes, by signing the bottom of this form, the institution certifies that no more than 10% of the institution’s grant under these programs will be used to develop this new qualified master’s degree program, as required by the statute governing these programs.

5. According to the statute governing the HBCU Master’s Degree Program, no institution that is eligible for and receives a grant under the following programs shall be eligible to apply for a grant, or receive grant funds under this program for the same fiscal year:

   • Historically Black Graduate Institutions (HBGI) Program (Title III, Part B of the HEA)

   • Promoting Postbaccalaureate Opportunities for Hispanic Americans (PPOHA) program (Title V, Part B of the HEA)

   • Predominantly Black Institutions Graduate (PBI-G) Program (Title VII, Subpart 4 of the HEA)

By signing the bottom of this form, the institution certifies that it will not apply for or receive funds from the HBGI, PPOHA, or PBI-G programs during the same fiscal year that it applies for and receives funds under the HBCU Master’s Degree Program.

6. _____ Check here if the applicant institution plans to use any program grant funds to establish or maintain an institutional endowment.

By signing the bottom of this form, the institution certifies that if it uses program funds to establish or maintain an institutional endowment, the institution agrees to abide by the Department of Education’s regulations governing the Endowment Challenge Grant Program, 34 CFR Part 628, and the program statute, Title III, Part C, Section 331 of the HEA.

Name of Institutional Representative (printed or typed):

Signature of Institutional Representative:

Date:

GOALS AND OBJECTIVES FORM
Please provide a detailed description of the activities to be supported using program funding, measurable goals and objectives that these activities will address, and the proposed outcomes to be used to evaluate the success of the funded activities. Please make sure that this form reflects the goals, activities and outcomes described in your Project Narrative. If more space is required, please attach an additional sheet.
Goals and Objectives		Activities	Proposed Outcomes
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Part II. Formula Elements

Please provide all of the information requested on the Formula Elements form and certify that the data is accurate. Formula elements may be found in the program statute, Title VII, Subpart 4, Sec.723 (f) (3). The data collected in this part of the application must be submitted by the institution annually by the deadline. If the space provided is insufficient, please attach an additional sheet.

Institution: __________________________________________________________

OPE ID: ________________

Formula Element A: The ability of the institution to match Federal Funds with non-Federal funds.

Has your institution matched Federal grant funds under a Federal program in the past five years?

___________Yes ___________ No

If YES, please provide the name of the Federal program, the amount of the institution’s matching contribution, and the fiscal year. If there was more than one Federal program under which your institution provided matching funds, please attach a sheet with that additional information.

Federal Program: _____________________________________________

Amount of Institutional Matching Contribution: $____________________

Fiscal Year in Which the Matching Took Place: FY ___________________

Formula Element B: The number of students enrolled in the qualified master’s degree program at the eligible institution in the previous academic year.

Qualified Master’s Degree Program	Number of Students Enrolled in [insert year]
Total:

Formula Element C: The average cost of attendance per student, for all full-time students enrolled in the qualified master’s degree program at the institution.

Average Cost of Attendance for Qualified Master’s Degree Program Students: $___________________

Formula Element D: The number of students in the previous year who received a degree in the qualified master’s degree program at each institution.

Qualified Master’s Degree Program	Number of Graduates in [insert year]
Total:

Formula Element E: The contribution, on a percent basis, of the programs for which the institution is eligible to receive funds under this program to the total number of African Americans receiving master’s degrees in the disciplines related to the programs for the previous year.

Column A	Column B	Column C	Column D
		(For ED Use Only: Do not fill in Columns C and D.)
Qualified Master’s Degree Program	Number of African American Graduates in [insert year]	Number of African American Graduates in this Discipline Nationwide in [insert year]	Percent of Total
Total:

Please have the President of the institution sign below:

I attest to the accuracy of the data provided.

President’s Name: (please print or type):____________________________________

President’s Signature: ___________________________________________________

Date: ____________________________

INTERGOVERNMENTAL REVIEW OF FEDERAL PROGRAMS

EXECUTIVE ORDER 12372

This program falls under the rubric of Executive Order 12372 (Intergovernmental Review of Federal Programs) and the regulations in 34 CFR Part 79. One of the objectives of the Executive order is to strengthen federalism--or the distribution of responsibility between localities, States, and the Federal government--by fostering intergovernmental partnerships. This idea includes supporting processes that State or local governments have devised for coordinating and reviewing proposed Federal financial grant applications.

The process for doing this requires grant applicants to contact State Single Points of Contact for information on how this works. Multi-state applicants should follow procedures specific to each state. Further information about the State Single Point of Contact process and a list of names by State can be found at:

http://www.whitehouse.gov/omb/grants_spoc

For State review programs, applicants may submit comments directly to the Department. All recommendations and comments must be mailed or hand-delivered by the date indicated in the actual application notice to the following address: The Secretary, EO 12372--CFDA# [84.382G], U.S. Department of Education, 400 Maryland Avenue, SW, Washington, DC 20202.

Proof of mailing will be determined on the same basis as applications (see 34 CFR §75.102). Recommendations or comments may be hand-delivered until 4:30:00 p.m. (Eastern Standard Time) on the closing date indicated in this notice.

Important note: The above address is not the same address as the one to which the applicant submits its completed applications. Do not send applications to the above address.

GENERAL EDUCATION PROVISIONS ACT (GEPA)

SECTION 427

Section 427 of GEPA requires all applicants for new awards to include in their applications a description of the steps the applicant proposes to take to ensure equitable access to, and participation in, its federally-assisted programs for students, teachers, and other program beneficiaries with special needs. The 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.

A general statement of an applicant’s nondiscriminatory hiring policy is not sufficient to meet this requirement. Applicants must identify potential barriers and explain steps they will take to overcome these barriers.

NOTE: Applicants for new awards must include information in their applications to address this provision in order to receive funding under this program.

GOVERNMENT PERFORMANCE AND RESULTS ACT (GPRA)

What is GPRA?

The Government Performance and Results Act of 1993 (GPRA) is a straightforward statute that requires all federal agencies to manage their activities with attention to the consequences of those activities. Each agency is to clearly state what it intends to accomplish, identify the resources required, and periodically report their progress to the Congress. In so doing, it is expected that the GPRA will contribute to improvements in accountability for the expenditures of public funds, improve Congressional decision-making through more objective information on the effectiveness of federal programs, and promote a new government focus on results, service delivery, and customer satisfaction.

How has the Department of Education Responded to the GPRA Requirements?

As required by GPRA, the Department of Education has prepared a strategic plan for 2018-2022. This plan reflects the Department’s priorities and integrates them with its mission and program authorities and describes how the Department will work to improve education for all children and adults in the U.S. The Department’s goals, as listed in the plan, are:

Strategic Goal 1: Support state and local efforts to improve learning outcomes for all P-12 students in every community.

Strategic Goal 2: Expand postsecondary educational opportunities, improve outcomes to foster economic opportunity and promote an informed, thoughtful and productive citizenry.

Strategic Goal 3: Strengthen the quality, accessibility and use of education data through better management, increased privacy protections and transparency.

Strategic Goal 4: Reform the effectiveness, efficiency and accountability of the Department.

What are the performance indicators for the Historically Black Colleges and Universities (HBCU-M) Master’s Degree Program?

The performance indicators for the HBCU-M Program are part of the Department’s plan for meeting Goal 2.

Program Goal: The purpose of the HBCU-M program is to award grants to eligible institutions making a substantial contribution to graduate education opportunities at the master’s degree level in the following areas: mathematics; engineering; the physical or natural sciences; computer science; information technology; nursing; allied health; or other scientific disciplines in which African Americans are underrepresented. The program provides grants for up to six years to establish or strengthen qualified master’s degree programs in these fields.

The performance indicators for the HBCU-M Program are:

• 
  Enrollment:

The percent change, over the period between the fall of the year the grant was issued and the fall after the end of the grant period, in the number of African American and/or low-income graduate students enrolled in the academic program(s) supported by the project.

• Degrees Awarded:

The percent change, over the fall semester before, in the number of African American and/or low-income students graduating in the academic program(s) supported by the project.

• Time to Degree:

Median time to completion of a master’s degree for African Americans and/or low-income graduate students, in the academic program(s) supported by the project during the period of the grant award.

• Efficiency Measure:

Cost per successful outcome: Federal cost per master’s degree earned by African American and/or low-income students, in the academic program(s) supported by the project during the period of the grant award.

Other performance measures are:

• New Courses:

Number of new courses, in the academic program(s) supported by the project, added as a result of this grant.

• New Academic Concentrations:

Number of academic concentrations, in the academic program(s) supported by the project, added as a result of this grant.

• New Research Initiatives:

Number of new research initiatives, in the academic program(s) supported by the project, added as a result of this grant.

• Student Independent Research:

Percentage of students participating in independent research, during the most recent complete academic year.

• Student Research with Faculty:

Percentage of students participating in research with faculty, during the most recent complete academic year.

• Student Conference Presentations:

Number of students presenting at conferences, during the most recent complete academic year.

• Student Publications:

Number of students writing for publication, during the most recent complete academic year.

How does the Department of Education determine whether performance goals have been met?

An applicant that receives a grant award will be required to submit annual progress reports and a final report as a condition of the award. The reports will document the extent to which project goals and objectives are met.

G5 E-APPLICATION SUBMISSION PROCEDURES AND TIPS FOR APPLICANTS

IMPORTANT – PLEASE READ FIRST

U.S. Department of Education

http://www.G5.gov

1. G5 e-Application Submission Procedures and Tips for Applicants

2. Instructions for the SF-424

3. Instructions for Department of Education Supplemental Information for SF-424

4. Definitions for Department of Education Supplemental Information for SF-424

5. Instructions for Phase II – The Comprehensive Development Plan (CDP)

6. Instructions for ED 524

7. Instructions for Completion of SF-LLL, Disclosure of Lobbying Activities

Register as an Applicant

To facilitate your use of G5 e-Application, this document includes important application preparation and submission procedures you need to be aware of to ensure your application is received in a timely manner and accepted by the Department of Education. Please read and follow these step-by-step directions to create and submit your application.

ATTENTION

Applicants using the Department of Education's G5 e-Application system will need to register first to access an application package. Forms in an application package are completed online and narratives are uploaded while logged into the system. Therefore, allow sufficient time to complete your application before the closing date. If you encounter difficulties, you may also contact the G5 helpdesk on 1-888- 336-8930. The following are steps you should follow to successfully complete an application using G5 e-Application. Please note that there is a training module available on the G5 home page (www.G5.gov) that details the registration and G5 application processes in detail for users new to G5. You can access this module under the Main Menu of the homepage and link to Online Training. Look for the training topic G5 for Applicants.

Step 1 – Register in G5 to access the electronic application package. If you are a new user, you will need to register to use G5 e-Application.

• From the G5 Portal Page http://www.G5.gov/, click on the Sign Up button for non-ED employees. The User Registration Screen displays.

• Click the button to the right of the ED Employee/ED Contractor field to display the employee/contractor options. Select the “no” list option. Enter all required information as noted by red asterisks (*).

• Click the continue button to proceed to the user registration agreement. Select the agree button to accept the terms of the user agreement, and then the Submit button. Note: If you do not agree, then you may not complete the registration process. The system displays a message indicating that the system will send a notification to your email address.

• The system sends a message with a link to activate your account. Clicking the link takes you to the Account Activation screen. Click the Agree option to accept the activation terms.

• Click on the Submit button to initiate your activation. Read the EDCAPS Security memorandum with the subject “G5 User ID and Password” and click the Continue > button. The next Account Activation screen will require you to complete the password, security question and security answer. Fill out the required fields and press the Continue button to move to the summary information. Click the Activate button to activate your account and save your password and security information. The system displays a message indicating that the account has been activated. You will now need to log into G5 where you will be taken to the My Profile page where you should select your role for access. In the Availability Types field, select “Applicant” from the list and Continue. Proceed through the next screen and Submit. You will then receive an email with the G5 link. Your applicant role may take a few minutes to activate.

If you already have a username and password for G5 use them to login. If you have access to more than one G5 module, you will be directed to select which module you wish to enter. Keep in mind that this username and password will be used for all G5 modules. In order to update your registration for additional G5 modules, click the appropriate tab on the top of the screen and provide the requested information.

The site is viewed best using Internet Explorer 5.5 or higher.

Step 2 – Add Application Package to your Start Page. From your Home Page, go to Grant Setup and click on “Package Submission.” Select the package for which you wish to apply and click on the "Initiate New Application” button. In the future, the package will now appear when you click on “Package Submission” or after using the “Click Here to view my Applications” link under “Quick View” on your Home Page.

Step 3 – Begin the Application. After going to the Application Package, click on the “Modify Application” button. This brings you to a page where you will see all of the application's forms and narratives listed.

Step 4 – Fill out Forms. Select the form you would like to complete and click on the “Edit Form” button to enter data. Remember to click the "Save" button at the bottom of the form and check the "Form Completed" box for each form as you complete it.

Step 5 – Upload File(s) for Narrative Responses. When prompted to attach narrative documents to application forms, enter the title of the document, and then Select the “Upload” button. Next, click on the "Browse" button to locate your file. Remember to click the "Save" button after you upload the document and check the "Form Completed" box when you finish uploading your file(s) and/or completing the form. Please note for file uploads, we accept .pdf files only.

Step 6 – Verify Information/Submit your Application. Verify your information is correct and complete before submitting. Only authorized individuals for your organization can submit an application. Please check with your certifying official or sponsored research office before submission. After all forms are completed, click on the "Continue" button at the bottom of your application. Enter and verify the Authorizing Representative information, and click the "Submit" button. At the top of the page you will see a confirmation message stating that your application was successfully submitted and providing you with your application number. You will also receive an e-mail to confirm that your application was received, and it will include your application number. Please print and keep this e-mail for your records. [Reminder: applications must be submitted before 4:30:00 pm, Washington, D.C. time, on the deadline date for applications. G5 e-Application will not accept your application if you try to submit it after 11:59:59 PM on the TBD.

Step 7 – Printing Your Completed Application. You have the option to print each form at any time by clicking on the “View Form” button after selecting the appropriate form to print. After submission of your application, you have the option to print a complete e-Application package in PDF. From the Application Packages tab you will notice that your application status has changed from Draft to Submitted. To locate the PDF of your application, select the package radio button and click the “Modify Application” button. Then select the “Click Here to view the PDF Package” in the upper right hand corner of the page under the Package Information section.

Step 8 – Fax the signed SF 424 Cover Page (or Program Specific Cover Page). Write your unique application number (received in step 8) on the upper right corner of your printed SF 424 Cover Page (or Program Specific Cover Page), and fax it to the Application Control Center (202) 245-6272 within 3 business days of submitting your e-Application. This may be optional for some programs.

NOTE: For more detailed information on submitting an e-Application, please see the User Guide. The Online Training can be found under the main menu at http://www.G5.gov.

Attaching Files – Additional Tips

Please note the following tips related to attaching files to your application:

1. Ensure that you only attach the Education approved file type detailed in the Federal Register application notice (read-only, non-modifiable .PDF files only). Also, do not upload any password protected files to your application.

2. When attaching files, applicants should limit the size of their file names. Lengthy file names could result in difficulties with opening and processing your application. We recommend you keep your file names to less than 50 characters.

3. PLEASE DO NOT USE SPECIAL/NON-ENGLISH CHARACTERS IN ANY FORM OR DOCUMENT (for example, %, *, /, etc.). Foreign characters or symbols includes words spelled with a non- English alphabet, such as “Boğaziçi” or “Nizām al-Dīn Gīlānī” or any word with an accent mark.

Both of these conditions (lengthy file names and/or special characters including in the file names) could result in difficulties opening and processing a submitted application.

4. Applicants should limit the size of their file attachments. Documents submitted that contain graphics and/or scanned material often greatly increase the size of the file attachments and can result in difficulties opening the files. Please note that each file attachment in e-Application has a file size limitation which is anywhere from 2 to 8 MB and the limitation will be indicated on the individual screen when you upload a file. For reference, however, the average discretionary grant application package totals 1 to 2 MB. Therefore, you may want to check the size of your attachments before uploading them into e-Application.

Other Submission Tips

SUBMIT EARLY – We strongly recommend that you do not wait until the last day to submit your application. The time it takes to upload the narratives for your application will vary depending on several factors including the size of the files and the speed of your Internet connection. If you try to submit your application after 4:30:00 PM Washington, DC time on the deadline date, the G5 e-Application system will not accept it.

1. If electronic submission is optional and you have problems that you are unable to resolve before the deadline date and time for electronic applications, please follow the transmittal instructions for hard copy applications in this notice and get a hard copy application postmarked by midnight on the deadline date.

If electronic submission is required, you must submit an electronic application before 4:30 PM unless you follow the procedures in this notice and qualify for one of the exceptions to the electronic submission requirement and submit, no later than two weeks before the application deadline date, a written statement to the Department that you qualify for one of these exceptions.

2. Dial-Up Internet Connections – When using a dial up connection to upload and submit your application, it can take significantly longer than when you are connected to the Internet with a high-speed connection. While times will vary depending upon the size of your application, it can take a few minutes to a few hours to complete your grant submission using a dial up connection. If you do not have access to a high-speed connection and electronic submission is required, you may want to consider following the instructions in this notice to obtain an exception to the electronic submission requirement no later than two weeks before the application deadline date.

3. Exception to Electronic Submission Requirement: You qualify for an exception to the electronic submission requirement, and may submit your application in paper format, if you are unable to submit an application through G5 because––

• You do not have access to the Internet; or

• You do not have the capacity to upload large documents to G5; and

No later than two weeks before the application deadline date (14 calendar days or, if the fourteenth calendar day before the application deadline date falls on a Federal holiday, the next business day following the Federal holiday), you mail or email a written statement to the Department, explaining which of the two grounds for an exception prevents you from using the Internet to submit your application. If you mail your written statement to the Department, it must be postmarked no later than two weeks before the application deadline date. If you email your written statement to the Department, we must receive the email statement no later than two weeks before the application deadline date. Address and mail or email your statement to: TBD, U.S. Department of Education, 400 Maryland Avenue, S.W., LBJ-250-, Washington, D.C. 20202, Attention: HBCU-MASTERS FY ___ Application, or Email: TBD.

Your paper application must be submitted in accordance with the U.S. Mail or hand delivery instructions described below.

1. Submission of Paper Applications by Mail

If you qualify for an exception to the electronic submission requirement, you may mail (through the U.S. Postal Service or a commercial carrier) your application to the Department. You must mail the original and two copies of your application, on or before the application deadline date, to the Department at the following address:

U.S. Department of Education

Application Control Center

Attention: (CFDA Number 84.382G)

LBJ Basement Level 1

400 Maryland Avenue, S.W.

Washington, DC 20202-4260

You must show proof of mailing consisting of one of the following:

1. A legibly dated U.S. Postal Service postmark

2. A legible mail receipt with the date of mailing stamped by the U.S. Postal Service

3. A dated shipping label, invoice, or receipt from a commercial carrier.

4. Any other proof of mailing acceptable to the Secretary of the U.S. Department of Education

If you mail your application through the U.S. Postal Service, we do not accept either of the following as proof of mailing:

1. A private metered postmark

2. A mail receipt that is not dated by the U.S. Postal Service

If your application is postmarked after the application deadline date, we will not consider your application.

Note: The U.S. Postal Service does not uniformly provide a dated postmark. Before relying on this method, you should check with your local post office.

2. Submission of Paper Applications by Hand Delivery

If you qualify for an exception to the electronic submission requirement, you (or a courier service) may deliver your paper application to the Department by hand. You must deliver the original and two copies of your application, by hand, on or before the application deadline date, to the Department at the following address:

U.S. Department of Education

Application Control Center

Attention: (CFDA Number 84.382G)

LBJ Basement Level 1

400 Maryland Avenue, S.W.

Washington, DC 20202-4260

The Application Control Center accepts hand deliveries daily between 8:00 a.m. and 4:30 p.m., Washington, D.C. time, except Saturdays, Sundays, and Federal holidays.

Note for Mail or Hand Delivery of Paper Applications: If you mail or hand deliver your application to the Department—

1. You must indicate on the envelope and--if not provided by the Department--in Item 11 of the SF 424 the CFDA number, including suffix letter, if any, of the competition under which you are submitting your application; and

2. The Application Control Center will mail to you a notification of receipt of your grant application. If you do not receive this grant notification within 15 business days from the application deadline date, you should call the U.S. Department of Education Application Control Center at (202) 245-6288.

INSTRUCTIONS FOR THE SF-424

This is a standard form required for use as a cover sheet for submission of pre-applications and applications and related information under discretionary programs. Some of the items are required and some are optional at the discretion of the applicant or the federal agency (agency). Required fields on the form are identified with an asterisk (*) and are also specified as “Required” in the instructions below. In addition to these instructions, applicants must consult agency instructions to determine other specific requirements.

Item	Entry:		Item:	Entry:
1.	Type of Submission: (Required) Select one type of submission in accordance with agency instructions. • Pre-application • Application • Changed/Corrected Application – Check if this submission is to change or correct a previously submitted application. Unless requested by the agency, applicants may not use this form to submit changes after the closing date.		10.	Name of Federal Agency: (Required) Enter the name of the federal agency from which assistance is being requested with this application.
			11.	Catalog of Federal Domestic Assistance Number/Title: Enter the Catalog of Federal Domestic Assistance number and title of the program under which assistance is requested, as found in the program announcement, if applicable.
2.	Type of Application: (Required) Select one type of application in accordance with agency instructions. • New – An application that is being submitted to an agency for the first time. • Continuation - An extension for an additional funding/budget period for a project with a projected completion date. This can include renewals. • Revision - Any change in the federal government’s financial obligation or contingent liability from an existing obligation. If a revision, enter the appropriate letter(s). More than one may be selected. If "Other" is selected, please specify in text box provided. A. Increase Award D. Decrease Duration B. Decrease Award E. Other (specify) C. Increase Duration		12.	Funding Opportunity Number/Title: (Required) Enter the Funding Opportunity Number (FON) and title of the opportunity under which assistance is requested, as found in the program announcement.
			13.	Competition Identification Number/Title: Enter the competition identification number and title of the competition under which assistance is requested, if applicable.
			14.	Areas Affected by Project: This data element is intended for use only by programs for which the area(s) affected are likely to be different than the place(s) of performance reported on the SF-424 Project/Performance Site Location(s) Form. Add attachment to enter additional areas, if needed.
3.	Date Received: Leave this field blank. This date will be assigned by the Federal agency.		15.	Descriptive Title of Applicant’s Project: (Required) Enter a brief descriptive title of the project. If appropriate, attach a map showing project location (e.g., construction or real property projects). For pre-applications, attach a summary description of the project.
4.	Applicant Identifier: Enter the entity identifier assigned buy the Federal agency, if any, or the applicant’s control number if applicable.
5a.	Federal Entity Identifier: Enter the number assigned to your organization by the federal agency, if any.		16.	Congressional Districts of: 16a. (Required) Enter the applicant’s congressional district. 16b. Enter all district(s) affected by the program or project. Enter in the format: 2 characters state abbreviation – 3 characters district number, e.g., CA-005 for California 5th district, CA-012 for California 12 district, NC-103 for North Carolina’s 103 district. If all congressional districts in a state are affected, enter “all” for the district number, e.g., MD-all for all congressional districts in Maryland. If nationwide, i.e. all districts within all states are affected, enter US-all. If the program/project is outside the US, enter 00-000. This optional data element is intended for use only by programs for which the area(s) affected are likely to be different than place(s) of performance reported on the SF-424 Project/Performance Site Location(s) Form. Attach an additional list of program/project congressional districts, if needed.
5b.	Federal Award Identifier: For new applications, enter NA. For a continuation or revision to an existing award, enter the previously assigned federal award identifier number. If a changed/corrected application, enter the federal identifier in accordance with agency instructions.
6.	Date Received by State: Leave this field blank. This date will be assigned by the state, if applicable.
7.	State Application Identifier: Leave this field blank. This identifier will be assigned by the state, if applicable.
8.	Applicant Information: Enter the following in accordance with agency instructions:
	a. Legal Name: (Required) Enter the legal name of applicant that will undertake the assistance activity. This is the organization that has registered with the Central Contractor Registry (CCR). Information on registering with CCR may be obtained by visiting www.Grants.gov.		17.	Proposed Project Start and End Dates: (Required) Enter the proposed start date and end date of the project.
	b. Employer/Taxpayer Number (EIN/TIN): (Required) Enter the employer or taxpayer identification number (EIN or TIN) as assigned by the Internal Revenue Service. If your organization is not in the US, enter 44-4444444.		18.	Estimated Funding: (Required) Enter the amount requested, or to be contributed during the first funding/budget period by each contributor. Value of in-kind contributions should be included on appropriate lines, as applicable. If the action will result in a dollar change to an existing award, indicate only the amount of the change. For decreases, enclose the amounts in parentheses.
	c. Organizational DUNS: (Required) Enter the organization’s DUNS or DUNS+4 number received from Dun and Bradstreet. Information on obtaining a DUNS number may be obtained by visiting www.Grants.gov.		19.	Is Application Subject to Review by State Under Executive Order 12372 Process? (Required) Applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State intergovernmental review process. Select the appropriate box. If “a.” is selected, enter the date the application was submitted to the State.
	d. Address: Enter address: Street 1 (Required); city (Required); County/Parish, State (Required if country is US), Province, Country (Required), 9-digit zip/postal code (Required if country US).		20.	Is the Applicant Delinquent on any Federal Debt? (Required) Select the appropriate box. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of federal debt include; but, may not be limited to: delinquent audit disallowances, loans and taxes. If yes, include an explanation in an attachment.
	e. Organizational Unit: Enter the name of the primary organizational unit, department or division that will undertake the assistance activity.		21.	Authorized Representative: To be signed and dated by the authorized representative of the applicant organization. Enter the first and last name (Required); prefix, middle name, suffix. Enter title, telephone number, email (Required); and fax number. A copy of the governing body’s authorization for you to sign this application as the official representative must be on file in the applicant’s office. (Certain federal agencies may require that this authorization be submitted as part of the application.)
	f. Name and contact information of person to be contacted on matters involving this application: Enter the first and last name (Required); prefix, middle name, suffix, title. Enter organizational affiliation if affiliated with an organization other than that in 7.a. Telephone number and email (Required); fax number.
9.	Type of Applicant: (Required) Select up to three applicant type(s) in accordance with agency instructions.
	A.     State Government B.     County Government C.     City or Township Government D.     Special District Government E.     Regional Organization F.     U.S. Territory or Possession G.    Independent School District H.     Public/State Controlled Institution of Higher Education I.      Indian/Native American Tribal Government (Federally Recognized) J.     Indian/Native American Tribal Government (Other than Federally Recognized) K.     Indian/Native American Tribally Designated Organization L.     Public/Indian Housing Authority	M.    Nonprofit N.     Private Institution of Higher Education O.    Individual P.     For-Profit Organization (Other than Small Business) Q.    Small Business R.     Hispanic-serving Institution S.     Historically Black Colleges and Universities (HBCUs) T.     Tribally Controlled Colleges and Universities (TCCUs) U.     Alaska Native and Native Hawaiian Serving Institutions V.     Non-US Entity W.    Other (specify)

[U.S Department of Education note: As of spring, 2010, the FON discussed in Block 12 of the instructions can be found via the following URL: http://www.grants.gov/applicants/find_grant_opportunities.jsp.]

INSTRUCTIONS FOR

DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424

1. Project Director. Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on matters involving this application.

2. Novice Applicant. Check “Yes” or “No” only if assistance is being requested under a program that gives special consideration to novice applicants. Otherwise, leave blank.

Check “Yes” if you meet the requirements for novice applicants specified in the regulations in 34 CFR 75.225 and included on the attached page entitled “Definitions for Department of Education Supplemental Information for SF 424.” By checking “Yes” the applicant certifies that it meets these novice applicant requirements. Check “No” if you do not meet the requirements for novice applicants.

3. Human Subjects Research. (See I. A. “Definitions” in attached page entitled “Definitions for Department of Education Supplemental Information for SF 424.”)

If Not Human Subjects Research. Check “No” if research activities involving human subjects are not planned at any time during the proposed project period. The remaining parts of Item 3 are then not applicable.

If Human Subjects Research. Check “Yes” if research activities involving human subjects are planned at any time during the proposed project period, either at the applicant organization or at any other performance site or collaborating institution. Check “Yes” even if the research is exempt from the regulations for the protection of human subjects. (See I. B. “Exemptions” in attached page entitled “Definitions for Department of Education Supplemental Information for SF 424.”)

3a. If Human Subjects Research is Exempt from the Human Subjects Regulations. Check “Yes” if all the research activities proposed are designated to be exempt from the regulations. Insert the exemption number(s) corresponding to one or more of the six exemption categories listed in I. B. “Exemptions.” In addition, follow the instructions in II. A. “Exempt Research Narrative” in the attached page entitled “Definitions for Department of Education Supplemental Information for SF 424.”

3a. If Human Subjects Research is Not Exempt from Human Subjects Regulations. Check “No” if some or all of the planned research activities are covered (not exempt). In addition, follow the instructions in II. B. “Nonexempt Research Narrative” in the page entitled “Definitions for Department of Education Supplemental Information for SF 424

3a. Human Subjects Assurance Number. If the applicant has an approved Federal Wide (FWA) on file with the Office for Human Research Protections (OHRP), U.S. Department of Health and Human Services, that covers the specific activity, insert the number in the space provided. If the applicant does not have an approved assurance on file with OHRP, enter “None.” In this case, the applicant, by signature on the SF-424, is declaring that it will comply with 34 CFR 97 and proceed to obtain the human subjects assurance upon request by the designated ED official. If the application is recommended/selected for funding, the designated ED official will request that the applicant obtain the assurance within 30 days after the specific formal request.

Note about Institutional Review Board Approval. ED does not require certification of Institutional Review Board approval with the application. However, if an application that involves non-exempt human subjects research is recommended/selected for funding, the designated ED official will request that the applicant obtain and send the certification to ED within 30 days after the formal request.

Paperwork Burden Statement. 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. The valid OMB control number for this information collection is 1894-0007. The time required to complete this information collection is estimated to average between 15 and 45 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form write directly to: Application Control Center, U.S. Department of Education, Potomac Center Plaza, 550 12^th Street, S.W. Room 7076, Washington, D.C. 20202-4260.

DEFINITIONS FOR

DEPARTMENT OF EDUCATION SUPPLEMENTAL INFORMATION FOR SF 424

(Attachment to Instructions for Supplemental Information for SF 424)

Definitions:

Novice Applicant (See 34 CFR 75.225). For discretionary grant programs under which the Secretary gives special consideration to novice applications, a novice applicant means any applicant for a grant from ED that—

• Has never received a grant or subgrant under the program from which it seeks funding;

• Has never been a member of a group application, submitted in accordance with 34 CFR 75.127-75.129, that received a grant under the program from which it seeks funding; and

• Has not had an active discretionary grant from the Federal government in the five years before the deadline date for applications under the program. For the purposes of this requirement, a grant is active until the end of the grant’s project or funding period, including any extensions of those periods that extend the grantee’s authority to obligate funds.

In the case of a group application submitted in accordance with 34 CFR 75.127-75.129, a group includes only parties that meet the requirements listed above.

PROTECTION OF HUMAN SUBJECTS IN RESEARCH

I. Definitions and Exemptions

A. Definitions.

A research activity involves human subjects if the activity is research, as defined in the Department’s regulations, and the research activity will involve use of human subjects, as defined in the regulations.

—Research

The ED Regulations for the Protection of Human Subjects, Title 34, Code of Federal Regulations, Part 97, define research as “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge.” If an activity follows a deliberate plan whose purpose is to develop or contribute to generalizable knowledge it is research. Activities which meet this definition constitute research whether or not they are conducted or supported under a program that is considered research for other purposes. For example, some demonstration and service programs may include research activities.

—Human Subject

The regulations define human subject as “a living individual about whom an investigator (whether professional or student) conducting research obtains (1) data through intervention or interaction with the individual, or (2) identifiable private information.” (1) If an activity involves obtaining information about a living person by manipulating that person or that person’s environment, as might occur when a new instructional technique is tested, or by communicating or interacting with the individual, as occurs with surveys and interviews, the definition of human subject is met. (2) If an activity involves obtaining private information about a living person in such a way that the information can be linked to that individual (the identity of the subject is or may be readily determined by the investigator or associated with the information), the definition of human subject is met. [Private information includes information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place, and information which has been provided for specific purposes by an individual and which the individual can reasonably expect will not be made public (for example, a school health record).]

B. Exemptions.

Research activities in which the only involvement of human subjects will be in one or more of the following six categories of exemptions are not covered by the regulations:

(1) Research conducted in established or commonly accepted educational settings, involving normal educational practices, such as (a) research on regular and special education instructional strategies, or (b) research on the effectiveness of or the comparison among instructional techniques, curricula, or classroom management methods.

(2) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior, unless: (a) information obtained is recorded in such a manner that human subjects can be identified, directly or through identifiers linked to the subjects; and (b) any disclosure of the human subjects’ responses outside the research could reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects’ financial standing, employability, or reputation. If the subjects are children, exemption 2 applies only to research involving educational tests and observations of public behavior when the investigator(s) do not participate in the activities being observed.

Exemption 2 does not apply if children are surveyed or interviewed or if the research involves observation of public behavior and the investigator(s) participate in the activities being observed. [Children are defined as persons who have not attained the legal age for consent to treatments or procedures involved in the research, under the applicable law or jurisdiction in which the research will be conducted.]

(3) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior that is not exempt under section (2) above, if the human subjects are elected or appointed public officials or candidates for public office; or federal statute(s) require(s) without exception that the confidentiality of the personally identifiable information will be maintained throughout the research and thereafter.

(4) Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.

(5) Research and demonstration projects which are conducted by or subject to the approval of department or agency heads, and which are designed to study, evaluate, or otherwise examine: (a) public benefit or service programs; (b) procedures for obtaining benefits or services under those programs; (c) possible changes in or alternatives to those programs or procedures; or (d) possible changes in methods or levels of payment for benefits or services under those programs.

(6) Taste and food quality evaluation and consumer acceptance studies, (a) if wholesome foods without additives are consumed or (b) if a food is consumed that contains a food ingredient at or below the level and for a use found to be safe, or agricultural chemical or environmental contaminant at or below the level found to be safe, by the Food and Drug Administration or approved by the Environmental Protection Agency or the Food Safety and Inspection Service of the U.S. Department of Agriculture.

II. Instructions for Exempt and Nonexempt Human Subjects Research Narratives

If the applicant marked “Yes” for Item 3 of Department of Education Supplemental Information for SF 424, the applicant must provide a human subjects “exempt research” or “nonexempt research” narrative. Insert the narrative(s) in the space provided. If you have multiple projects and need to provide more than one narrative, be sure to label each set of responses as to the project they address.

A. Exempt Research Narrative.

If you marked “Yes” for item 3 a. and designated exemption numbers(s), provide the “exempt research” narrative. The narrative must contain sufficient information about the involvement of human subjects in the proposed research to allow a determination by ED that the designated exemption(s) are appropriate. The narrative must be succinct.

B. Nonexempt Research Narrative.

If you marked “No” for item 3 a. you must provide the “nonexempt research” narrative. The narrative must address the following seven points. Although no specific page limitation applies to this section of the application, be succinct.

(1) Human Subjects Involvement and Characteristics: Provide a detailed description of the proposed involvement of human subjects. Describe the characteristics of the subject population, including their anticipated number, age range, and health status. Identify the criteria for inclusion or exclusion of any subpopulation. Explain the rationale for the involvement of special classes of subjects, such as children, children with disabilities, adults with disabilities, persons with mental disabilities, pregnant women, prisoners, institutionalized individuals, or others who are likely to be vulnerable

(2) Sources of Materials: Identify the sources of research material obtained from individually identifiable living human subjects in the form of specimens, records, or data. Indicate whether the material or data will be obtained specifically for research purposes or whether use will be made of existing specimens, records, or data.

(3) Recruitment and Informed Consent: Describe plans for the recruitment of subjects and the consent procedures to be followed. Include the circumstances under which consent will be sought and obtained, who will seek it, the nature of the information to be provided to prospective subjects, and the method of documenting consent. State if the Institutional Review Board (IRB) has authorized a modification or waiver of the elements of consent or the requirement for documentation of consent.

(4) Potential Risks: Describe potential risks (physical, psychological, social, legal, or other) and assess their likelihood and seriousness. Where appropriate, describe alternative treatments and procedures that might be advantageous to the subjects.

(5) Protection Against Risk: Describe the procedures for protecting against or minimizing potential risks, including risks to confidentiality, and assess their likely effectiveness. Where appropriate, discuss provisions for ensuring necessary medical or professional intervention in the event of adverse effects to the subjects. Also, where appropriate, describe the provisions for monitoring the data collected to ensure the safety of the subjects.

(6) Importance of the Knowledge to be Gained: Discuss the importance of the knowledge gained or to be gained as a result of the proposed research. Discuss why the risks to subjects are reasonable in relation to the anticipated benefits to subjects and in relation to the importance of the knowledge that may reasonably be expected to result.

(7) Collaborating Site(s): If research involving human subjects will take place at collaborating site(s) or other performance site(s), name the sites and briefly describe their involvement or role in the research.

Copies of the Department of Education’s Regulations for the Protection of Human Subjects, 34 CFR Part 97 and other pertinent materials on the protection of human subjects in research are available from the U.S. Department of Education, Protection of Human Subjects Coordinator, Office of the Chief Financial Officer, LBJ Building, 400 Maryland Avenue, SW, Washington, D.C. 20202-4250, telephone: (202) 260-3353, and on the U.S. Department of Education’s Protection of Human Subjects in Research Web Site: http://www.ed.gov/about/offices/list/ocfo/humansub.html

NOTE: The State Applicant Identifier on the SF 424 is for State Use only. Please complete it on the OMB Standard 424 in the upper right corner of the form (if applicable).

INSTRUCTIONS FOR ED 524

General Instructions

This form is used to apply to individual U.S. Department of Education (ED) discretionary grant programs. Unless directed otherwise, provide the same budget information for each year of the multi-year funding request. Pay attention to applicable program specific instructions, if attached. You may access the Education Department General Administrative Regulations cited within these instructions at: https://www.ecfr.gov/cgi-bin/text-idx?SID=0b63ce6f20caccbf480e5596fdf289e3&mc=true&tpl=/ecfrbrowse/Title34/34cfr75_main_02.tpl. You may access requirements from 2 CFR 200, “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards” cited within these instructions at: https://www.ecfr.gov/cgi-bin/text-idx?SID=6214841a79953f26c5c230d72d6b70a1&tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl. You must consult with your Business Office prior to submitting this form.

Section A - Budget Summary

U.S. Department of Education Funds

All applicants must complete Section A and provide a break-down by the applicable budget categories shown in lines 1-11.

Lines 1-11, columns (a)-(e): For each project year for which funding is requested, show the total amount requested for each applicable budget category.

Lines 1-11, column (f): Show the multi-year total for each budget category. If funding is requested for only one project year, leave this column blank.

Line 13, columns (a)-(e): Show the total budget request for each project year for which funding is requested.

Line 13, column (f): Show the total amount requested for all project years. If funding is requested for only one year, leave this space blank.

Indirect Cost Information: If you are requesting reimbursement for indirect costs on line 10 the indirect cost rate to be charged to the grant must be entered in the applicable field on line 10, and the following information is to be completed by your Business Office.

(1): Indicate whether or not your organization has an Indirect Cost Rate Agreement that was approved by the Federal government. If you checked “no,” ED generally will authorize grantees to use a temporary rate of 10 percent of budgeted salaries and wages (complete (4) of this section when using the temporary rate) subject to the following limitations:

(a) The grantee must submit an indirect cost proposal to its cognizant agency within 90 days after ED issues a grant award notification; and

(b) If after the 90-day period, the grantee has not submitted an indirect cost proposal to its cognizant agency, the grantee may not charge its grant for indirect costs until it has negotiated an indirect cost rate agreement with its cognizant agency.

(2): If you checked “yes” in (1), provide a copy of your Indirect Cost Rate Agreement and indicate in (2) the beginning and ending dates covered by the Indirect Cost Rate Agreement. In addition, indicate whether ED, another Federal agency (Other) or State agency issued the approved agreement. If you check “Other,” specify the name of the Federal or other agency that issued the approved agreement.

(3): If you check “no” in (1), indicate in (3) if you want to use the de minimis rate of 10 percent of MTDC (see 2CFR § 200.68). If you use the de minimis rate, you are subject to the provisions in 2 CFR § 200.414(f). Note, you may only use the 10 percent de minimis rate if you are a first-time Federal grant recipient, and you do not have an Approved Indirect Cost Rate Agreement. You may not use the de minimis rate if you are a State, Local government, or Indian Tribe, or if your grant is funded under a training rate or restricted rate program.

(5): If you are applying for a grant under a Restricted Rate Program (34 CFR 75.563 or 76.563), indicate whether you are using a restricted indirect cost rate that is included on your approved Indirect Cost Rate Agreement, or whether you are using a restricted indirect cost rate that complies with 34 CFR 76.564(c)(2). Note: State or Local government agencies may not use the provision for a restricted indirect cost rate specified in 34 CFR 76.564(c)(2). Check only one response. Leave blank, if this item is not applicable.

(6): For Training Rate Programs, ED regulations limit non-governmental entities to the recovery of indirect costs on training grants to the grantee’s actual indirect costs, as determined by its negotiated rate agreement, or 8 percent of a MTDC, whichever is lower (see EDGAR § 75.562(c)(4)). The 8 percent limit also applies to cost-type contracts under grants, if these contracts are for training as defined in EDGAR § 75.562(a). If a non-governmental entity that receives a grant under a training grant program does not have an approved indirect cost rate and wants to recover indirect costs, it may use a temporary rate of 10 percent of budgeted direct salaries and wages, but it must submit an indirect cost rate proposal to its cognizant agency for indirect costs within 90 days after ED issues the GAN. After the 90-day period, the government entity may not charge its grant for indirect costs until it has negotiated an indirect cost rate agreement.

Section B - Budget Summary

Non-Federal Funds

If you are required to provide or volunteer to provide cost-sharing or matching funds or other non-Federal resources to the project, these should be shown for each applicable budget category on lines 1‑11 of Section B.

Lines 1-11, columns (a)-(e): For each project year, for which matching funds or other contributions are provided, show the total contribution for each applicable budget category.

Lines 1-11, column (f): Show the multi-year total for each budget category. If non-Federal contributions are provided for only one year, leave this column blank.

Line 12, columns (a)-(e): Show the total matching or other contribution for each project year.

Line 12, column (f): Show the total amount to be contributed for all years of the multi-year project. If non-Federal contributions are provided for only one year, leave this space blank.

Section C - Budget Narrative [Attach separate sheet(s)]

Pay attention to applicable program specific instructions,
if attached.

1. Provide an itemized budget breakdown, and justification by project year, for each budget category listed in Sections A and B. For grant projects that will be divided into two or more separately budgeted major activities or sub-projects, show for each budget category of a project year the breakdown of the specific expenses attributable to each sub-project or activity.

2. For non-Federal funds or resources listed in Section B that are used to meet a cost-sharing or matching requirement or provided as a voluntary cost-sharing or matching commitment, you must include:

a. The specific costs or contributions by budget category;

b. The source of the costs or contributions; and

c. In the case of third-party in-kind contributions, a description of how the value was determined for the donated or contributed goods or services.

[Please review cost sharing and matching regulations found in 2 CFR 200.306.]

3. If applicable to this program, provide the rate and base on which fringe benefits are calculated.

4. If you are requesting reimbursement for indirect costs on line 10, this information is to be completed by your Business Office. Specify the estimated amount of the base to which the indirect cost rate is applied and the total indirect expense. Depending on the grant program to which you are applying and/or your approved Indirect Cost Rate Agreement, some direct cost budget categories in your grant application budget may not be included in the base and multiplied by your indirect cost rate. For example, you must multiply the indirect cost rates of “Training grants" (34 CFR 75.562) and grants under programs with “Supplement not Supplant” requirements ("Restricted Rate" programs) by a “modified total direct cost” (MTDC) base (34 CFR 75.563 or 76.563). Please indicate which costs are included and which costs are excluded from the base to which the indirect cost rate is applied.

When calculating indirect costs (line 10) for "Training grants" or grants under "Restricted Rate" programs, you must refer to the information and examples on ED’s website at: http://www.ed.gov/fund/grant/apply/appforms/appforms.html.

You may also contact (202) 377-3838 for additional information regarding calculating indirect cost rates or general indirect cost rate information.

5. Provide other explanations or comments you deem necessary.

If Applicable Section D - Budget Summary

Limitation on Administrative Expenses.

If your program is subject to an administrative cost cap (as indicated Section III.2.C of the program’s Notice Inviting Applications (NIA)), fill out this form as follows:

1. On the top of the page, list the percentage cap on administrative costs, and indicate whether your administrative cost cap applies to both indirect and direct costs, or only direct costs (from Section III.2.C of the program’s NIA).

2. IF the cost cap applies to both indirect and direct costs:

1. Fill out the entire table noting your administrative costs, including line 8. Line 8 is taken from Section A, line 10. For lines 1-6, these are only direct administrative costs; do not include in lines 1-6 any costs included in your indirect cost rate. If your program has a matching requirement (see NIA), include in lines 1-6 the administrative portions of the applicable rows from both Section A and Section B. If there is no program matching requirement, only use Section A.

2. Ensure that the line 10 percentage DOES NOT EXCEED the percentage cap on administrative costs. If your program does not have a matching requirement, divide line 9 by Section A line 12. If your program does have a matching requirement, to calculate line 10, divide line 9 by the sum of Section A line 12 and Section B line 12.

3. IF the cost cap applies ONLY to direct costs:

1. Fill out the entire table noting your administrative costs, EXCLUDING line 8.

Ensure that the line 10 percentage DOES NOT EXCEED the percentage cap on administrative costs. If your program does not have a matching requirement, divide line 7 by Section A line 9. If your program does have a matching requirement, to calculate line 10, divide line 7 by the sum of Section A line 9 and Section B line 9).

Paperwork Burden Statement

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. The valid OMB control number for this information collection is 1894-0008. The time required to complete this information collection is estimated to vary from 13 to 22 hours per response, with an average of 17.5 hours per response, including the time to review instructions, search existing data sources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to the Office of Finance and Operations, Office of Acquisitions and Grants Administration, Grants Policy and Training Division, U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202.

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., “RFP-DE-90-001.”

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503