Hud-50070

Certification for
a Drug-Free Workplace

U.S. Department of Housing
and Urban Development

Public reporting burden. Public reporting burden for this
Public reporting
burden.isPublic
reporting
burden3for
thisper
collection of information is estimated to average 0.25 hours per response, including the time for reviewing instructions,
collection
of information
estimated
to average
hours
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Comments regarding the accuracy of this
response, including the time for reviewing instructions, searching
burden estimate and any suggestions for reducing this burden can be sent to: U.S. Department of Housing and Urban Developme nt, Office of the Chief Data Officer, R, 451 7th St SW,
existing data sources, gathering and maintaining the data needed,
Room
8210, Washington,
DC 20410-5000.
Doofnot
send completed forms to this address. This agency may not collect this information, and you are not required to complete this form,
and
completing
and reviewing
the collection
information.
unless it displays a currently valid OMB control number. HUD is authorized to collect this information under the authority cited in the Notice of Fu nding Opportunity for this grant
Comments regarding the accuracy of this burden estimate and
program. The information collected will provide proposed budget data for multiple programs. HUD will use this information in the selection of applicants. This information is required to
any suggestions for reducing this burden can be sent to: U.S.
obtain the benefit
sought
inUrban
the grant
program. This
information
Department
of Housing
and
Development,
Office
of the will not be held confidential and may be made available to the public in accordance with the Freedom of Information Act
(5 U.S.C. §552).
Chief Data Officer, R, 451 7th St SW, Room 8210, Washington, DC
20410-5000. Do not send completed forms to this address. This
agency may not collect this information, and you are not required
to complete this form, unless it displays a currently valid OMB
Applicant Name
control number. HUD is authorized to collect this information
under the authority cited in the Notice of Funding Opportunity for
this grant program. The information collected will provide
proposed
budget data
for multiple
programs.
HUD will use this
Program/Activity
Receiving
Federal
Grant Funding
information in the selection of applicants. This information is
required to obtain the benefit sought in the grant program. This
information will not be held confidential and may be made
available to the public in accordance with the Freedom of
ActingActon
behalf
of the above named Applicant as its Authorized Official, I make the following certifications and agreements to the
Information
(5 U.S.C.
§552).

Department of Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue to
provide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use
of a controlled substance is prohibited in the Applicant's workplace and specifying the actions that will be taken against
employees for violation of such prohibition.
b. Establishing an on-going drug-free awareness program to
inform employees --(1) The dangers of drug abuse in the workplace;
(2) The Applicant's policy of maintaining a drug-free
workplace;
(3) Any available drug counseling, rehabilitation, and
employee assistance programs; and
(4) The penalties that may be imposed upon employees for
drug abuse violations occurring in the workplace.
c. Making it a requirement that each employee to be engaged in
the performance of the grant be given a copy of the statement
required by paragraph a.;
d. Notifying the employee in the statement required by paragraph
a. that, as a condition of employment under the grant, the employee
will ---

(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction
for a violation of a criminal drug statute occurring in the workplace
no later than five calendar days after such conviction;
e. Notifying the agency in writing, within ten calendar days
after receiving notice under subparagraph d.(2) from an employee or otherwise receiving actual notice of such conviction.
Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on
whose grant activity the convicted employee was working,
unless the Federalagency has designated a central point for the
receipt of such notices. Notice shall include the identification
number(s) of each affected grant;
f. Taking one of the following actions, within 30 calendar days of
receiving notice under subparagraph d.(2), with respect to any
employee who is so convicted --(1) Taking appropriate personnel action against such an
employee, up to and including termination, consistent with the
requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily
in a drug abuse assistance or rehabilitation program approved for
such purposes by a Federal, State, or local health, law
enforcement, or other appropriate agency;
g. Making a good faith effort to continue to maintain a drug-free
workplace through implementation of paragraphs a. thru f.

2. Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding
of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code. Identify each sheet with the
Applicant name and address and the program/activity receiving grant funding.)

Check here

if there are workplaces on file that are not identified on the attached sheets.

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.
(18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Name of Authorized Official
Title
Signature

Date

X
form HUD-50070 (3/98)
ref. Handbooks 7417.1, 7475.13, 7485.1 & .3