State, Local, Tribal Competitive

OMB Control No.: 0584-0512

Expiration Date: xx/xx/xxxx

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, 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 0584-0512. The time required to complete this information collection is estimated to average 60 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 1320 Braddock Place, 5^th Floor, Alexandria, VA 22314 ATTN: PRA (0584-0512).  Do not return the completed form to this address.

U.S. Department of Agriculture

Food and Nutrition Service

FY 20XX Increasing Enrollment in WIC

through Medicaid and SNAP Grant

REQUEST FOR APPLICATIONS

CFDA#

RFA Release Date: X XX, 20XX

Letter of Intent (Optional) is due: X XX, 20XX

Application Submission Date: X XX, 20XX

Anticipated Award Date: X XX, 20XX

TABLE OF CONTENTS PAGE

1. PROGRAM DESCRIPTION 3

2. FEDERAL AWARD INFORMATION 4

• Full Grants 5

• Mini Grants 5

• Important Dates 5

• FY 20XX Focus area 5

3. ELIGIBILITY INFORMATION 6

4. APPLICATION AND SUBMISSION INFORMATION 8

• Grant Application Format and Content Requirements 8

• Application Format 10

• Application Content 12

5. APPLICATION REVIEW INFORMATION 21

• Evaluation Factors and Criteria 21

• Review and Selection Process 24

6. FEDERAL AWARD ADMINISTRATION INFORMATION 24

• Grant Requirements 25

7. FEDERAL AWARDING AGENCY CONTACTS 33

8. OTHER INFORMATION 33

SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

FISCAL YEAR (FY) 20XX Increasing Enrollment in WIC through Medicaid and SNAP Grant REQUEST FOR APPLICATION (RFA)

1. PROGRAM DESCRIPTION

Purpose

The Food and Nutrition Service (FNS) administers the nutrition assistance programs of the United States Department of Agriculture (USDA). The mission of FNS is to work with partners to provide food and nutrition education to people in need in a way that inspires public confidence and supports American agriculture.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides Federal grants to State agencies for supplemental foods, health care referrals, and nutrition education, including breastfeeding promotion and support, for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. Starting in 1995 (and based on available funding), FNS has awarded Special Project Grants to support opportunities to improve the delivery of WIC services.

The purpose of the fiscal year (FY) 20XX WIC Special Project Grants is to help WIC State Agencies develop, implement, and evaluate new or innovative methods of service to meet the changing needs of WIC participants. Section 17(h)(10)(III) of the Child Nutrition Act of 1966, as amended, authorizes funding for the WIC Special Project Grants, which are intended to improve the delivery of program services and demonstrate national or regional significance.

In order to be considered for funding, a project must: test new and effective ideas; include a strong evaluation component with measurable results; and be designed in way that the key project activities can be replicated or transferred to other WIC Programs nationally.

Brief descriptions of previously awarded WIC Special Project Grants are located on the USDA FNS public website at the following link: http://www.fns.usda.gov/wic/wic-special-project-grants. For more information about previous Special Project Grants, please visit the WIC Works Resource System Sharing Gallery that includes a list of completed projects as well as final reports and materials: https://wicworks.fns.usda.gov/wicworks/Sharing_Center/gallery/special_grants.html

Applicants may find this site helpful in exploring possibilities for viable use of grant funding.

FY 20XX Increasing Enrollment in WIC through Medicaid and SNAP Grant Webinar

Within the first few weeks of the release of this RFA, FNS will host a webinar to review the RFA, the focus area, and provide guidance on how to apply for a grant. This webinar will be most helpful to those State agencies who have not applied for a Special Project Grant in recent years. Information on the webinar will be posted to the Announcements page of the FNS Partner Web: https://www.partnerweb.usda.gov/Lists/Announcements/shortlist.aspx.

2. FEDERAL AWARD INFORMATION

Purpose of Grant Funding

USDA’s Food and Nutrition Service (FNS) expects to award approximately $XX000,000 in fiscal year (FY) 20XX grant funding to WIC State agencies for WIC Special Projects Grants. These grant awards are contingent upon the availability of funding and will be awarded as cooperative agreements to allow FNS more active participation with the grantee during both project development and project execution. Should additional funding be made available, FNS will use those funds to make additional awards. FNS reserves the right to award additional grantees with no further competition in subsequent years.

Only the 90 WIC State agencies responsible for administering WIC in the States, Territories, and Indian Tribal Organizations (ITOs) may apply as a lead agency for the grant. However, successful grants depend on partnerships between the lead State agency and local WIC agencies, local colleges or universities, public health organizations (government or non-government), Head Start programs or other similar programs serving low income families with children under 5 years of age. Strong collaborations within States and local agencies enhance the delivery of WIC services and therefore, it is strongly recommended that State agencies reach out to their local WIC agencies for collaborative inputs in the proposal development process.

Local WIC agencies may also reach out to their State agencies with innovative ideas relevant for collaboration on proposal development for Full or Mini Grants, and they may leverage existing partnerships with academic institutions and other local organizations (government or non-government) during the proposal development process.

Regardless of the approach, State agencies are responsible to lead all Full and Mini Grant proposals and partnerships. In coordination with their State, local agencies may manage a Mini Grant project that will be based out of their location.  However, State agencies will still be responsible for the submission of all Mini Grant proposals, as well all oversight activities related to implementation of the grant.  

This RFA is for Full or Mini Grants ONLY

Applicants must indicate if they are applying for a Full or Mini Grant.

Full Grants - FNS anticipates awarding Full Grants up to a maximum of $X each, depending on the number and quality of applications received and requested budget amounts. FNS reserves the right to fund a higher amount for projects that are particularly innovative and have a budget that supports awarding additional funds. The performance period will be from the date of the award through xx, 202X. (Note: While all major project activities must be completed by xx, 202X, grantees will be required to present project findings to FNS in Fall 202X. See Grant Requirements for more information.)

Mini Grants - FNS anticipates awarding Mini Grants up to $X- $X each, depending on the number and quality of applications received and requested budget amounts. The performance period will be from the date of the award through XX 20XX. (Note: While all major project activities must be completed by XX 20XX, grantees will be required to present final project findings to FNS in Fall 20XX. See Grant Requirements for more information.)

FNS reserves the right to reduce, increase, or revise proposed budgets based on the availability of funds. FNS also reserves the right to cancel this RFA in whole or in part if funds are not available. FNS also reserves the right to increase the number of grants awarded under this competition.

Important Dates

Xx, xx, 20XX	Letter of Intent to submit an application (optional) is due to FNS. See Attachment A Letter of Intent.
xx, 20XX	Applications are due to FNS
XXXX XX, 20XX	WIC Special Project Grants will be awarded

FY 20XX Project Focus Area

The focus area of the FY 20XX WIC Special Project Full and Mini Grants is Optimizing WIC Service Delivery.

This is an opportunity for State agencies to examine their processes and identify opportunities for more efficient delivery of Program services. FNS suggests that State agencies focus on innovative ways to improve upon any and all aspects of: Certification, Eligibility and Coordination; Nutrition Education; and Vendor Management in their applications.

Successful applications will focus on solutions that make effective use of independent research and creativity; solutions that reveal new insight into current challenges in the WIC program and offer creative approaches to overcome those challenges.

Examples of successful projects may include, but are not limited to:

1. Collaborate with area hospitals, pediatricians, Indian Health Service Hospitals (where applicable) to certify eligible WIC participants in hospitals.

2. Collaborate with local and community programs to bring WIC services to eligible community members.

3. Deliver nutrition education through an innovative platform and/or with new entities in order to provide more efficient service delivery. Assess the efficacy of new initiatives to improve participant-centered nutrition services. An example of such a program is the Massachusetts Touching Minds and Hearts program, which trains WIC staff on emotion-based counseling in order to build rapport and assist participants’ with behavior change. For examples of other participant-centered models please visit the WIC Works Resource System at: https://wicworks.fns.usda.gov/topics-z/participant-centered-services .

4. Improve participant experience in the store through the improvement of location of foods, signage, vendor staff training, etc.

5. Develop strategies to assist small stores increase their stock of, fresh fruits and vegetables.

6. Develop/improve a WIC vendor advisory group to identify and address areas that are of joint concern to the program and vendors.

The USDA FNS will consider Full and Mini Grant applications proposing to evaluate other focus areas outside of this year’s theme, as long as the projects are aimed at helping State agencies develop, implement and evaluate new or innovative methods of service delivery to meet the changing needs of WIC participants.

3. ELIGIBILITY INFORMATION

1. Eligible Applicants

FNS is seeking geographic diversity in awarding this year’s grants. Grants may be awarded to individual WIC State agencies or to a consortium of WIC State agencies, as long as one of the agencies is designated the lead agency. FNS encourages smaller State agencies and ITOs to consider collaborating with other WIC State agencies or ITOs on grant applications. Individual State agencies may submit only one application for a Full or Mini Grant per year. If a State agency submits an application as part of a consortium of agencies, it may not also submit a separate individual application.

2. Cost Sharing or Matching Requirements

There are no cost sharing or matching requirements to participate in either the Full or Mini Grants.

1. Pre-application Screening Requirements

In reviewing applications in any discretionary grant competition, Federal Awarding Agencies, in accordance with 2 CFR 200.400, are required, prior to making a Federal award, to review information available through various OMB-designated repositories for eligibility qualification or financial integrity, and to have in place a framework for evaluating the risks posed by applicants before they receive Federal awards. The evaluation of the information obtained from the designated repository systems and the risk assessment may result in FNS imposing special conditions that correspond to the degree of risk assessed. The Federal repository systems FNS will review include:

1. SAM, the System for Award Management, the Official U.S. Government system that consolidated the capabilities of CCR/FedReg, ORCA, and EPLS;

2. FAPIIS, the Federal Awardee Performance and Integrity Information System, is a database that has been established to track contractor misconduct and performance;

3. Dun and Bradstreet, the system where applicants establish a DUNS number which is used by the Federal government to better identify related organizations that are receiving funding under grants and cooperative agreements, and to provide consistent name and address data for electronic grant application systems. The Federal government requires that all applicants for Federal grants and cooperative agreements with the exception of individuals other than sole proprietors have a DUNS number.

4. U.S. Department of Agriculture, AD-3030, Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants.

Applicants must also respond to the pre-application assessment questions below to allow FNS to evaluate aspects of the applicant’s financial stability, quality of management systems, and history of performance, reports and findings from audits. A questionnaire containing these questions has been provided to facilitate the process. Applicants must answer all the pre-application questions. While answering “yes” may be an indicator of risk, the consideration and evaluation of these questions is only an indicator of potential risk and may or may not result in additional oversight requirements or special conditions be placed on an award should an award be made. Decisions regarding additional oversight requirements will take into consideration the total number of risks identified.

1. Has your organization received a Federal award within the past 3 years?

Yes_____ No_____

2. Does your organization utilize accounting software to manage your financial records?

Yes_____ No_____

3. Does your accounting system identify the receipt and expenditure of program funds separately for each grant?

Yes_____ No_____

4. Does your organization have a dedicated individual responsible for monitoring organizational funds, such as an accountant or a finance manager?

Yes_____ No_____

5. Is there a separation of duties for staff handling the approval of transactions and the recording and payment of funds?

Yes_____ No_____

6. Does your organization have the ability to specifically identify and allocate employee effort to an applicable program?

Yes_____ No_____

7. Does your organization have a property/inventory management system in place to track the location and value of equipment purchased under the award?

Yes_____ No_____

8. Has your organization been audited within the last 5 fiscal years?

Yes_____ No_____

9. If the answer to question number 8 is yes, was this report issued under the Single Audit requirement? If no, a hyperlink or copy of the report will be required.

Yes_____ No_____

10. If answer to question 8 is yes, was there a “Qualified Opinion” or “Adverse Opinion”?

Yes_____ No_____

11. If answer to question 8 is yes, is there a material weakness disclosed?

Yes_____ No_____

12. If answer to question 8 is yes, is there a significant deficiency disclosed?

Yes_____ No_____

4. APPLICATION AND SUBMISSION INFORMATION

Applicants may obtain the RFA package by downloading the application from the grants.gov site at www.grants.gov website.

Applicants may also request a paper copy of this solicitation and required forms by contacting the FNS Grants Officer at:

XXXX XXXX, Grants Officer

Grants and Fiscal Policy Division

U.S. Department of Agriculture, FNS

3101 Park Center Drive, Room 740

Alexandria, VA 22302

E-mail: [email protected]

The complete application package must be uploaded to the grants.gov web portal at www.grants.gov on or before -, DATE 20XX at 11:59 PM, Eastern Daylight Savings Time. FNS will not accept applications sent via U.S. Mail, email, fax, or those that are hand-delivered. Applications received after the deadline date and/or time will be deemed ineligible and will not be reviewed or considered. FNS WILL NOT consider any additions or revisions to applications once they are received. Only WIC State Agencies may submit applications and coordinate all proposal development efforts from local agencies. Collaboration with local WIC agencies is strongly recommended as well as other academic institutions, government or non-government organizations serving children under 5 years (ex: Head Start). The web site grants.gov is a government-wide web site designed for electronic submission of applications/proposals. We advise that you allow ample time to familiarize yourself with the system’s requirements. We strongly recommended that you begin the submission process sufficiently in advance of the due date to ensure your application package is received on or before the deadline in case there are problems with the government-wide website.

Applicants experiencing difficulty submitting applications to www.grants.gov should contact the grants.gov Support Center at Local Toll Free: 1-800-518-4726 or via email at [email protected].

1. In order to submit your application via www.grants.gov, you must have obtained a Data Universal Numbering System (DUNS) number and registered in both the new System for Award Management (SAM) and on grants.gov. All applicants must have current SAM status at the time of application submission and throughout the duration of a Federal Award in accordance with 2 CFR Part 25. Please visit the following websites to obtain additional information on how to obtain a DUNS number (www.dnb.com) and register in SAM (https://www.sam.gov/portal/public/SAM/). Additional information is contained under the section entitled “Application Format”.

2. Please be aware that the grants.gov system provides several confirmation notices; you need to be sure that you have confirmation that the application was accepted. Please send an e-mail to Kimberly Shields, the Grants Officer at [email protected] advising that your application has been submitted through the www.grants.gov portal and that you have received a confirmation notice from www.grants.gov

3. Applications submitted without all the required supporting documents, forms, certification, and signatures will not be considered for competition. See Attachment B: Application Checklist for a list of everything that must be included in the application.

4. FNS strongly encourages eligible applicants interested in applying to this program to adhere to the following application format:

• “8 ½ by 11” page size white paper with at least 1 inch margins on the top and bottom.

• All pages should be single-spaced, in 12 point Times New Roman or Arial font size (smaller font may be used in tables, charts and graphs as long as they are clearly readable).

5. The number of pages for the entire Application should be no more than 25 pages for Full Grants and 12 pages for Mini Grants, excluding appendices or attached resumes. Narrative may not be in a font size smaller than 12 point Times New Roman or Arial. There is no page limit to resumes. Other Appendices may not exceed 15 pages for Full Grants and 8 pages for Mini Grants.

6. Applications must clearly indicate submission of a Full or Mini WIC Special Project Grant.

All questions regarding the application should be referred to:

XXXX XXXX, Grants Officer

Grants and Fiscal Policy Division

U.S. Department of Agriculture, FNS

3101 Park Center Drive, Room 740

Alexandria, VA 22302

E-mail: [email protected]

GRANT APPLICATION FORMAT AND CONTENT REQUIREMENTS

In general the grant proposals should:

1. Include a clear description of the planned project or intervention and how it would address the focus area.

2. Identify major goals, and clearly defined objectives and outcome measures of the project.

3. Explain how the project would be implemented and discuss its sustainability and transferability.

4. Include plans for an evaluation component. See Project Evaluation below for Full or Mini Grant for more information.

Application Format:

See Attachment B: Application Checklist for more information.

Additional Submission Information

In order to submit your application via www.grants.gov, you must have obtained a Data Universal Numbering System (DUNS) number and registered in both the new Systems for Award Management (SAM) and on grants.gov. The applicant is strongly advised to allow ample time to initiate its grants.gov application submission. All applicants must have current CCR status at the time of application submission and throughout the duration of a Federal Award in accordance with 2 CFR Part 25. Please visit the following websites to obtain additional information on how to obtain a DUNS number (www.dnb.com) and register in SAM (https://www.sam.gov/portal/public/SAM/).

What is SAM?

The System for Award Management (SAM) is combining Federal procurement systems and the Catalog of Federal Domestic Assistance into one new system. This consolidation is being done in phases. The first phase of SAM incorporated the functionality from several systems, including the Central Contractor Registry (CCR).

For additional information regarding SAM see the following link:

https://www.acquisition.gov/SAM_Guides/Quick%20Guide%20for%20Grants%20Registrations%20v1.pdf. Below is some additional information that should assist the applicant through this process:

DUNS Number: In order to obtain a DUNS number, if your organization does not have one, or if you are unsure of your organization’s number you can contact Dun and Bradstreet via the internet at http://fedgov.dnb.com/webform or by calling 1-888-814-1435, Monday thru Friday, 8am-9pm EST. There is no fee associated with obtaining a DUNS number. Obtaining a DUNS number may take several days to obtain.

SAM Registration: For applicant organizations that were previously registered in the CCR, relevant applicant information is already in SAM; set up a SAM account as necessary to update any information. To register in SAM, the applicant’s DUNS number, Tax ID Number (TIN), and taxpayer name (as it appears on the applicant’s last tax return) are all required. SAM verifies all information submitted by the applicant using several systems. This verification takes at least 48 hours after your registration is submitted to SAM. Applicants must have a valid SAM registration no later than 3 days prior to the application due date of this solicitation. Applicants that do not receive confirmation that SAM registration is complete and active should contact SAM at: https://www.fsd.gov/app/answers/list.

Grants.gov Registration: In order to apply for a grant, your organization must have completed the above registrations as well as register on grants.gov. The grants.gov registration process can be accessed at: www.grants.govapplicants/get_reistered.jsp. Generally, the registration process takes between 3-5 business days.

Allow your entity ample time to complete the necessary steps, for the submission of your grant application package, on grants.gov.

Please be aware that the grants.gov system provides several confirmation notices; applicants should ensure receipt of confirmation that the application was accepted. For tools and tips regarding www.grants.gov, please visit: http://www.grants.gov/web/grants/applicants/applicant-tools-and-tips.html.

PLEASE BE AWARE: In some instances the process to complete the migration of permissions and/or the renewal of the entity record will require 5-7 days or more. We strongly encourage grantees to begin the process at least 3 weeks before the due date of the grant solicitation.

NOTICE: Special Characters not supported

All applicants MUST follow grants.gov guidance on file naming conventions. To avoid submission issues, please follow the guidance provided in the grants.gov Frequently Asked Questions (FAQ):

Are there restrictions on file names for any attachment I include with my application package?

File attachment names longer than approximately 50 characters can cause problems processing packages. Please limit file attachment names. Also, do not use any special characters (example: &,–,*, %, /, #’, -), this includes periods (.), spacing followed by a dash in the file and for word separation, use underscore (example: Attached_File.pdf) in naming the attachments. Please note that if these guidelines are not followed, your application will be rejected. FNS will not accept any application rejected from www.grants.gov portal due to incorrect naming conventions.

Please be aware that the grants.gov system provides several confirmation notices; you need to be sure that you have confirmation that the application was accepted.

Application Content

For Full Grants, FNS requires applicants to partner with academic universities or research institutions/entities which bring specific expertise in developing grant applications and conducting research projects. This partnership does not need to be fully executed by the time the application is submitted in order to receive project funding, but must be in place – and documentation to that effect provided to FNS – by 3 months post award in order for the grant award and funding to be continued.

FNS encourages, to the extent appropriate, but does not require collaboration with outside entities for Mini Grant applications

Applicants must respond to all of the sections described below. Please use this organizational format as it will make it easier for grant reviewers to locate the requested information and to evaluate each application. If this format is not used it may result in reviewers’ being unable to locate the requested information within the application. Included in this RFA is Attachment B Application Checklist to assist applicants.

1. Introductory Material

1. Cover Letter

2. Title Page with:

• Project Summary: A one-paragraph description of your project covering both the planned intervention and its evaluation. This paragraph will provide the basis for any short summaries of the proposed grant that FNS prepares during the procurement process.

• Single Point of Contact: Designate a single point of contact for your application.

Provide the individual’s name, title, mailing address, phone number, fax number, and email address.

3. Table of Contents

2. Abstract

Full Grant: Approximately 2-3 pages

Mini Grant: One page

Provide a summary of your project that includes:(1) a description of how your project meets the focus area*; (2) a description of your planned intervention that specifies the nature of the intervention, the targeted audience (e.g., WIC staff, all WIC participants, WIC participants meeting specified criteria), and how the intervention will be implemented; (3) goals and objectives of the intervention; (4) project environment; (5) project evaluation, including its basic research questions, research design, and planned data collection (required for Full Grants only), and (6) key personnel.

*The Focus Area for the FY 20XX WIC Special Projects Grants is Optimizing WIC Service Delivery. For both Full and Mini Grants, FNS will consider grant applications proposing to evaluate other focus area(s) as long as the projects are aimed at helping State agencies develop, implement and evaluate new or innovative methods of service delivery to meet the changing needs of WIC participants. See General Information for more information.

3. Project Design and Implementation

Full Grant: Approximately 4-6 pages.

Mini Grant: Approximately 2-3 pages.

Provide a description of the following:

1. Need for Project: Discuss the problem that the proposed project addresses and how the expected results of the project can be used to improve program services in your State and at either the regional or national level. A post award Needs Assessment with input from WIC local agencies is recommended to refine the project design and implementation plans.

2. Goals: List and discuss each goal of the project design and implementation.

3. Objectives: For each of the goals, list and discuss the associated objective(s). Objective(s) should be specific, measurable, and realistic (e.g. increase participation of children ages 1-4 by 25%; increase parents’ servings of whole grain foods by one serving per day; reduce no-show rates of child recertification appointments by 30%).

4. Tasks: Discuss tasks that will be undertaken during both project design and implementation (e.g., design a nutrition education intervention, select participants for the intervention, train staff to perform the intervention, modify or develop training materials) and evaluation (e.g., assign or recruit local offices to intervention and comparison groups, develop and test data collection instruments, collect data, analyze data, and report evaluation findings). Planned tasks must be necessary to meet the project’s stated goals and objectives.

5. Environment: Depending on the structure of your project, respond to one and only one of the following. Choose the one that is most appropriate for your particular project.

• For projects that are intended to operate solely at the State agency level (e.g., analysis of data from participation reports), provide a State-level description of relevant characteristics that impact the operation of the project (e.g., participant characteristics, equipment, space, staffing, program operations, etc.). Provide a justification for operating the project at the State agency level.

• For interventions that will be implemented only within selected local WIC clinics and/or partner agencies, provide a local level description of relevant characteristics that impact the operation of the project (e.g., participant characteristics, equipment, space, staffing, and program operations, etc.). Provide a justification for your proposed choice of local clinics and/or partner agencies.

• For interventions that will be implemented only within selected local WIC clinics and/or partner agencies in which clinics or agencies have not yet been selected, provide a description of how you intend to select appropriate clinics or agencies. Provide a justification for your selection criteria.

Note that FNS does not recommend interventions that will be implemented State-wide in every local WIC clinic or agency. Without a control or comparison group (e.g., local WIC clinics or agencies in which the intervention has not been implemented), it is very difficult to develop a research design that can adequately evaluate the impacts of an intervention.

6. Letters of Support: If applicable, provide documentation of agreements or Memoranda of Understanding with local WIC clinics and/or partner agencies in an appendix to the proposal that does not exceed 15 pages in length (does not count toward the 25-page limit on proposal length).

4. Project Evaluation:

Full Grant: Approximately 3-5 pages

Mini Grant: One page

Project Evaluation for Full Grants: The evaluation component of the grant is essential. State agencies applying for funding for a Full Grant should include a staff person with experience in designing, developing, implementing and evaluating social or public health research projects. This person could be a social scientist or someone with a public health nutrition or public health research background from a university, consulting firm, institute, or government agency. The following publications are available for assistance in developing the evaluation component:

• WIC Evaluation Resource Guide, available at: http://www.fns.usda.gov/wic-evaluation-resource-guide

• Nutrition Education: Principles of Sound Impact Evaluation, available at: http://www.fns.usda.gov/nutrition-education-principles-sound-impact-evaluation

1. Type of Evaluation (Full Grants):

There are three types of evaluations commonly used to assess WIC and other social programs. Process or implementation evaluations provide detailed descriptive information on the way a program operates or an intervention is implemented. Outcome assessments or impact evaluations are usually more quantitative in nature and are designed to rigorously estimate actual project outcomes or impacts. The third type of evaluation, cost-benefit analysis, compares the estimated cost of a project with its estimated benefits. Mixed-method evaluations are acceptable.

Indicate the type(s) of evaluation methods you are planning to use.

2. Research Design (Full Grants):

Note: For Full Grants FNS requires applicants to partner with academic universities or research institutions/entities which bring specific expertise in developing grant applications and conducting research projects. This partnership does not need to be fully executed by the time the application is submitted in order to receive project funding, but must be in place - and documentation to that effect provided to FNS - by 3 months post award in order for the grant award and funding to be continued.

1. Research Questions: For each of the objectives of the project design and implementation, list and discuss specific research questions that will be answered during the evaluation (e.g., Does the proposed intervention improve the Nutrition Education process, if so, by how much? Do the results of the intervention differ by participant characteristics such as ethnicity and age of participant?).

2. Measures: For each research question, discuss specific measures that you will use (e.g., participation reports by age and other demographics, surveys of participants and /or staff, etc.). Discuss the strengths and weaknesses of the proposed measures.

3. Research Methods: Discuss the methods that will be used to answer the research questions, including:

• Sampling plan(s) and expected sample size(s).

• Data collection methods (how, by whom, how often, when).

• Data analysis methods (how and by whom).

• Strengths and weaknesses of the research methods.

Project Evaluation for Mini Grants: For project evaluation purposes, please describe the data elements you will collect and submit to FNS how often the data will be collected. For example, you may describe how Program participation data is collected from your existing Management Information System and how you will share this data with FNS as part of the quarterly progress reports (see Grant Requirements for more information about reporting requirements). Please also identify and define your baseline participation.

5. Sustainability and Transferability:

Full Grant: Approximately 2 pages

Mini Grant: One page

1. Sustainability: Confirm that the planned intervention meets all WIC regulations and guidance. Discuss how your project and its results will be sustained financially and administratively once the grant ends. If the project is a one-time project designed only to be performed during the grant period, discuss why it is sufficient as a one-time project and how the results will be used in the future.

2. Transferability: Discuss how your project and its results might inform other WIC State agencies and the feasibility (both financial and administrative) of implementing it in other states. Discuss plans for preparing and disseminating a final report, resources and materials developed as a result of the project, including how and with whom the report and materials will be shared (e.g., FNS, National WIC Association, conferences, universities, and journals). Extensive dissemination of project results, resources and materials is expected so that other State agencies will have the opportunity to replicate the project and/or learn from its results. (Note: FNS reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for Federal Government purposes any work developed under a grant. For more information see 40 CFR Part 31.34 in Attachment C, Terms and Conditions). For an application to be successful, it is essential that the project results be used to improve WIC Program services, and that they are applicable at the State and/or local agency level. FNS is especially interested in projects that utilize the WIC Works Resource System to disseminate information/resources. Information about this system may be found at https://wicworks.fns.usda.gov/

6. Key Personnel:

Full Grant: Approximately 3-4 pages.

Mini Grant: One page.

1. Applicants are responsible for identifying the individuals in their applications who qualify as key personnel. Key personnel can include individuals receiving funding through this grant, individuals who are making an in-kind contribution, and contractors/sub-contractors. Key personnel generally are identified as those individuals who:

• Have a direct bearing on the outcome of the project by their participation.

• Bear a substantive responsibility for developing, modifying and achieving the objectives of the project.

• Are responsible for managing, administering, conducting or providing oversight for a significant component of the project.

2. Please provide the following information for all identified key personnel:

• Indicate the individual’s current position and what their title will be on the proposed project.

• Describe the individual’s specific role and duties on the project. Where possible, make reference to the project design/ implementation or project evaluation narrative (i.e., Jane Doe will be responsible for developing the training curriculum described on page 10 of the application).

• Identify time commitment for each key staff with percentages of FTE or total work hours per month for each of the three years of the project.

For Full Grant applications only, please provide the following additional information for all identified key personnel:

• Describe prior relevant experience and how it relates to project duties.

• In an appendix, provide a current resume or curriculum vitae for the individual.

• In an appendix, provide a letter of commitment from the individual’s supervisor indicating the individual’s time commitment to the project.

• For key project positions that are currently vacant that must be filled in the course of the project, provide the following information: 1) the position title; 2) in an appendix, a detailed position description with required qualifications, skills, and knowledge; 3) a description of specific roles and duties on the project, making reference back to the project or evaluation narrative; 4) an anticipated date of hire; and 5) what arrangements will be made if the position is not filled in a timely manner.

• Identify all other projects, job positions (governmental and/or contractual), and other work-related commitments that each key staff member will be scheduled to work on during the Full grant time-frame.

3. For key personnel (and especially evaluation personnel or organizations), please identify any potential conflicts of interest (actual or perceived) that might prevent an independent and objective assessment of the implementation, impacts, or benefits of the proposed intervention (e.g., having a contractor both develop and assess an intervention). If any conflicts are identified, provide a discussion of what steps the State agency will take to ensure an objective and complete evaluation.

7. Management and Budget Plan: (Approximately 3-5 pages)

Full Grant: Approximately 3-5 pages.

Mini Grant: Approximately 2-3 pages.

1. Management Plans

1. Chain of Command and Responsibilities: Provide an organizational chart that indicates who has authority over whom, with a written description. Discuss how task leaders will be held accountable to keep the project on time and within budget. Describe how and by whom quarterly performance reports to FNS will be prepared.

2. Contingency Plans: Discuss contingency plans for ensuring that the project is not unduly disrupted by problems in development of intervention materials, development or clearance of data collection instruments, recruitment of sites or participants, availability of key personnel, or other unforeseen factors. With regard to key personnel, identify specific individuals who will be able to take over project tasks if proposed staff is not available during the project, and indicate their qualifications to do so. Otherwise, discuss the process you will use to select qualified replacements.

3. Outside Personnel: Discuss how and by whom relationships with all personnel outside of the primary grantee agency will be managed (e.g., personnel from local WIC clinics or partner agencies, personnel from other State agencies, university personnel, consultants, and contractors).

4. Task Table: Present a table which includes, in chronological order, every distinct task involved in both the project design and implementation and the project evaluation (e.g., implementation of new procedures pertinent to the project, survey development, training activities, data collection, data analysis, report writing), the beginning and ending date of each task, and the key staff person(s) responsible for overseeing/working on the task. The sample task table below, though neither comprehensive nor complete, demonstrates the first few project design, implementation and evaluation tasks of a sample project.

Sample Task Table

Task No.	Task Name	Description	Date Begins	Date Ends	Responsible Staff
1	Develop Curriculum	Develop Curriculum for use in the infant feeding practices nutrition education intervention	9/29/17	12/31/17	Jane Doe, Project Director & Suzy Que, Nutritionist
2	Test Curriculum	Field test the curriculum with 15 participants and 3 staff, hold focus groups with staff and with participants to identify necessary changes	1/1/17	2/1/17	Suzy Que, Nutritionist
3	Analyze Focus Group Data	Code, enter, and analyze data gathered in focus groups, identify necessary curriculum changes.	2/1/17	2/15/17	Jack Data, research analyst
4	Revise Curriculum	Revise curriculum based on results of focus groups	2/15/17	3/15/17	Suzy Que, Nutritionist
5	Develop KAB pre & post tests	Develop surveys to test infant feeding knowledge of participants before and after intervention	2/15/17	3/15/17	Lori Sample, Evaluation Consultant
6	Pre-test surveys	Field test the KAB pre & posttest surveys with 15 participants	3/16/17	4/10/17	Jack Data, research analyst.

2. Budget and Justification:

1. Budget: Provide line item detail and calculations for each budget object class identified in Section B, Budget Categories (a-j), of SF 424A. Details of calculation(s) must include estimation methods, quantities, unit costs, and other similar detail sufficient for it to be duplicated. Budget details must be provided for both Federal and non-Federal resources.

The budget narrative should provide enough detail for reviewers to easily understand how costs were determined and how they relate to the goals and objectives of the project. (Please see Attachment D, Budget Narrative Checklist and Forms).

For purposes of preparing the budget, “Federal resources” refers only to the requested WIC Special Project Grant funds. Non-Federal resources are all other Federal and non-Federal resources, including in-kind contributions. It is suggested that budget amounts and computations be presented in a columnar format: first column, object class categories; second column, Federal resources; next column, non-Federal resources; and last column, total budget. A separate budget page is required for each budget year requested as well as a total across all years. As part of your budget, please assume the following:

• Full Grant: One meeting per year for four years (including the final meeting and presentation of results to occur within 9 months of completion of the project) at FNS headquarters. Project expenditures through the final meeting must be included in the budget and expended prior to the grant expiration date. The annual meetings will be scheduled for 2 days (travel may be necessary the day before and/or after a meeting). Each State agency should plan to send up to two participants. It is required that one participant be from the WIC State agency, and is strongly recommended that one participant be an evaluator.

• Mini Grant: One meeting at the end of the project period (tentatively Fall 20XX) at FNS Headquarters in Alexandria, VA. Project expenditures through the meeting date must be included in the budget and expended prior to the grant expiration date. The meeting will be scheduled for two days (travel may be necessary the day before and/or after a meeting). Each State agency should plan to send one participant.

A sample budget table is provided for illustrative purposes on the next page. It is not comprehensive, and the unit costs and rates of pay are not necessarily intended to represent standard or reasonable costs.

2. Budget Justification: For each part of Section B, Budget Categories, applicants must submit a written justification for each budget category. The written justification should: 1) describe how the categorical costs were derived (i.e., price comparisons, standard government cost, estimates by proposed local vendor, prior experience with similar projects, etc.); 2) discuss the necessity, reasonableness and allocability of proposed costs; and 3) when possible, link expenditures to specific project activities/tasks. For any contractual costs, please also provide a justification for the proposed selection method (i.e., competitive or sole source).

3. Indirect cost rate agreements (ICRA): Applicants claiming indirect costs must provide a copy (in an appendix) of an approved ICRA for all indirect costs and a written explanation for how the indirect costs were applied to the budget. If indirect costs are not being claimed, then please indicate such.

4. Procurement: Grantees will comply with the procurement requirements listed at 2 CFR part 200.317.

8. Required Grant Application Forms

The following forms must be included:

• Standard Form 424 – Application and Instruction for Federal Assistance

• Standard Form 424A – Budget Information and Instruction

• Standard Form 424B – Assurances – Non-Construction Programs

• Standard Form LLL–Disclosure of Lobbying Activities

• Certification Regarding Lobbying (See Attachment D)

These forms are at the USDA Forms site: http://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms.

IX. Appendices

Full Grant: Not to exceed 15 pages for items B-E below.

Mini Grant: Not to exceed 8 pages for items B-E below.

Each of the following sections may be included as a separate appendix:

• Resumes and curriculum vitae for key personnel (No page limit).

• Letters of commitment from supervisors of key personnel.

• Job descriptions for key personnel that must be hired.

• Copies of agreements, Memoranda of Understanding, letters of intent with local WIC clinics and/or partner agencies. (For Full Grants, the partnership with academic universities or research institutions/entities does not need to be fully executed by the time the application is submitted in order to receive project funding, but must be in place – and documentation to that effect provided to FNS - by 3 months post award in order for the grant award and funding to be continued.)

• Any other supporting documentation.

Sample Budget Table (Year 1)

Object Class Categories	Federal Resources	Non-Federal Resources	Total
Personnel	$25,000	$10,500	$35,500
Jane Doe, Project Director	$50,000 [email protected] FTE=$20,000		$20,000
Suzy Que, Nutritionist		$35,000 [email protected] FTE=$10,500	$10,500
Jack Data, Research Analyst	$50,000 salary @.10 FTE=$5,000		$5,000
Fringe Benefits	$5,000	$2,100	7,100
Jane Doe, Project Director	$20,000*.20 fringe rate=$4,000		$4,000
Suzy Que, Nutritionist		$10,500*.20 fringe rate=$2,100	$2,100
Jack Data, Research Analyst	$5,000*.20 fringe rate=$1,000		$1,000
Travel	$2,356		$2,356
Travel to FNS headquarters	Airfare@$600 x 2 staff + perdiem @$145 x 2 staff x 2 days = $1780		$1780
Meetings between staff	.32 per mile@150 miles x 4 trips x 3 staff = $576		$576
Equipment	$2,000		$2,000
Computer	1 computer @ $2,000		$2,000
Supplies	$150		$150
Photocopying	1000 copies @ .05/copy = $50		$50
FedEx	20 FedEx packages @ $5.00 = $100		$100
Contractual	$50,000		$50,000
Evaluation Consultant	$50,000		$50,000
Construction	$0		$0
Other	$1400		$1400
Long-distance	3000 minutes @ .30/minute = $900		$900
Conference call with FNS and other grantees	1 call @ $100		$100
Total Direct	$85,506	$12,600	$98,106
Indirect Charges	$9,000	$3,780	$12,780
	.30 indirect rate * $30,000 salaries and fringe = $9,000	.30 indirect rate * $12,600 salaries and fringe = $3,780
Totals	$94,506	$16,380	$110,886

5. APPLICATION REVIEW INFORMATION

1. Evaluation Factors and Criteria

All applications will undergo an initial screening to verify completeness and adherence to proposal preparation instructions (see Grant Application Format and Content Requirements and Attachment C, Terms and Conditions of Award). Applications that do not meet this initial screen will not be evaluated further.

FNS reserves the right to select, rank, and order applicants. FNS will prioritize applications based on geographic diversity and those that meet agency priorities.

The following selection criteria will be used to evaluate applications for this RFA:

Project Design and Implementation (25 points)

The significance of the problem to be addressed is demonstrated, and specific gaps or weaknesses in regional or national services have been identified and will be addressed through the proposed project.

A Needs Assessment (to include WIC local agency input) process is included in the project design.

Project goals, objectives, and outcome measures are clearly identified and appropriate.

Project design and implementation tasks follow directly from project goals and objectives and the necessity of the tasks are adequately explained.

The environment in which the project will operate is appropriate and compatible with project goals and objectives, and proper justifications for the choice of the environment are provided. If applicable, letters of support or Memoranda of Understanding are included in the application.

Project design maximizes engagement with partners and helps uncover the most effective delivery models that include cost effectiveness, practicality, and creativity.

Proposal offers innovative ideas that make effective use of independent research and creativity; solutions that reveal new insight into Program challenges, and offer new approaches to overcome those challenges.

Project Evaluation – Full Grant Applications Only (20 points)

Extent to which the research/project design, including research questions, measures, sampling, data collection, and data analysis is thorough, feasible and appropriate to the goals and objectives of the project.

Research plan includes appropriate and feasible use of a pre-post and/or treatment/comparison design with randomization. If such a research design is not appropriate for the proposed project, the proposal explains why, indicates the range of alternative designs considered, and provides a thoughtful explanation for the design proposed.

Extent to which the research plan incorporates the findings of the Needs Assessment.

Potential problems and weaknesses with the research/project design are acknowledged and discussed.

Strength of the evaluator, including length of experience in the field.

Project Evaluation – Mini Grant Applications Only (20 Points)

Extent to which the project evaluation component is feasible and consistent with this project’s goals and objectives.

Quality of the applicant’s proposed data collection and evaluation plans.

Potential problems and weaknesses with the research/project design are acknowledged and discussed.

Sustainability and Transferability (20 points)

Feasibility of incorporating project purposes, activities, or results into the ongoing program of the agency at the end of Federal funding.

Transferability of the project and its results for adaptation and implementation by other WIC State agencies.

A dissemination plan to enable WIC State agencies to access and reproduce resources and materials developed as a result of the project.

Key Personnel (15 points)

Key personnel have the necessary education, skills, and experience for their proposed roles on the project. Supporting documentation (e.g., resume/vitae, position descriptions for vacant positions) is included for all key personnel.

The time commitment, duties, staffing mix, and concurrent staff responsibilities within and outside the grant (i.e. staff responsibilities with other projects, job positions, consultant work, etc.), contingency plans, and a clearly defined chain of command of key personnel are reasonable and appropriate to successfully complete the grant. Supporting documentation (i.e., letters of commitment from supervisors) should be included for all key personnel.

Management and Budget Plan (20 points)

The management plan provides a task description and table that demonstrates a thorough understanding of the tasks, timeline, and staffing needed to complete the project successfully. The management plan also provides the oversight necessary to ensure high quality products, services, or outcomes, and to keep the project on time and within budget (including appropriate plans for managing outside personnel).

The budget request is adequate to support the project and detailed calculations and budget for both Federal and non-Federal resources are provided.

Appropriate budget justifications are provided, including descriptions of how categorical costs were derived, discussions of necessity, reasonableness, and allocability of costs, and links between expenditures and activities/tasks. If applicable, justifications for contract selection methods (especially sole source procurements) are provided.

2. Review and Selection Process

After initial screening, FNS will assemble a peer panel group to review and determine the technical merit of each grant application. The panel will evaluate the proposals based on how well they address the required application components and array the applications from highest to lowest score. The peer panel members will recommend applications for consideration for a grant award based on the evaluation scoring. The selecting official reserves the right to accept the panel’s recommendation or to select an application for funding out of order to meet agency priorities, program balance, geographical representation or project diversity. FNS reserves the right to use this solicitation and competition to award additional grants with no further competition in the next fiscal year should additional funds be made available through future appropriations.

NOTE: if a discrepancy exists between the total funding request (submitted on SF-424, SF-424A), and budget or budget narrative within the application package in response to this solicitation, FNS will only consider and evaluate the estimated funding request contained on the SF-424.

6. FEDERAL AWARD ADMINISTRATION INFORMATION

After evaluation and scoring, grant applications will be arrayed by score, starting with the highest score. In general, awards will be made in ranking order until available funds are committed. However, if the selecting officials determine that, based upon their scores, few of the applications are of technical merit, FNS can award no grants or less than the total amount of funds set aside for this purpose. In addition, FNS reserves the option to select grantees out of ranking order to ensure geographic diversity, regional representation, or agency priority.

Once the grant is awarded, the State agency must sign an agreement containing the terms and conditions of the grant contained in the regulations listed below. (A copy of these regulations may be obtained at http://www.gpoaccess.gov/cfr/index.html.) Applicants must agree to comply with the USDA regulations below, which codify Office of Management and Budget (OMB) circulars, as follows:

2 CFR Part 25: “Universal Identifier and Central Contractor Registration”

2 CFR Part 170: “Reporting Sub-award and Executive Compensation Information”

2 CFR Part 175: “Trafficking Victims Protection Act;”

2 CFR Part 180: “OMB Guidelines to Agencies on Government wide Debarment

and Suspension (Non-procurement)”

2 CFR Part 417: “Office of the Chief Financial Officer: Department of Agriculture

Implementation of OMB Guidance on Non-Procurement

Debarment and Suspension”

GRANT REQUIREMENTS

Federal Award Notice

Unless an applicant receives a signed award document with terms and conditions, any contact from an FNS grants or program officer should not be considered as a notice of a grant award. No pre-award or pre-agreement costs incurred prior to the effective start date are allowed unless approved and stated on FNS’ signed award document.

The federal government is not obligated to make any award as a result of this RFA. Only the recognized FNS authorized signature can bind the USDA, Food and Nutrition Service to the expenditure of funds related to an award’s approved budget.

Administrative and National Policy Requirements

CONFIDENTIALITY OF AN APPLICATION

When an application results in an award, it becomes a part of the record of FNS transactions, available to the public upon specific request.  Under the Privacy Act of 1974, information that the Secretary determines to be of a confidential, privileged, or proprietary nature will be held in confidence to the extent permitted by law.  Therefore, any information that the applicant wishes to have considered as confidential, privileged, or proprietary should be clearly marked within the application.  Furthermore, the applications for authorization contain personally identifying information on individuals doing business with Food and Nutrition Service.  Therefore, the Food and Nutrition Service published USDA e-Authentication Service (system of records) July 26, 2006 in the Federal Register Volume 71 page 42346 to specify the uses to be made of the information in this collection.  Access to records is limited to those persons who process the records for the specific uses stated in this Privacy Act notice.  Records are kept in physically secured rooms and/or cabinets.  Paper records are segregated and physically secured in located cabinets.  Various methods of computer security limit access to records in automated databases.    Any application that does not result in an award will be not released to the public.  An application may be withdrawn at any time prior to the final action thereon.

CONFLICT OF INTEREST AND CONFIDENTIALITY OF THE REVIEW PROCESS

The agency requires all panel reviewers to sign a conflict of interest and confidentiality form to prevent any actual or perceived conflicts of interest that may affect the application review and evaluation process. Names of applicants, including States and Tribal Organizations, submitting an application will be kept confidential, except to those involved in the review process, to the extent permitted by law. In addition, the identities of the reviewers will remain confidential throughout the entire process. Therefore, the names of the reviewers will not be released to applicants.

ADMINISTRATIVE REGULATIONS

Federal Tax Liabilities Restrictions

None of the funds made available by this or any other Act may be used to enter into a contract, Memorandum of Understanding, or cooperative agreement with, make a grant to, or provide a loan or loan guarantee to, any corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless a Federal agency has considered suspension or debarment of the corporation and has made a determination that this further action is not necessary to protect the interests of the Government.

Felony Crime Conviction Restrictions

None of the funds made available by this or any other Act may be used to enter into a contract, Memorandum of Understanding, or cooperative agreement with, make a grant to, or provide a loan or loan guarantee to, any corporation that was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless a Federal agency has considered suspension or debarment of the corporation and has made a determination that this further action is not necessary to protect the interests of the Government.

Debarment and Suspension 2CFR Part 180 and 2 CFR Part 417

(a) The grantee agrees to ensure that all sub-grantees are neither excluded nor disqualified under the Suspension and Debarment rules found at 2 CFR part 180.300 by doing any one of the following:

• Checking the System for Awards Management (SAM). This information can be found at www.sam.gov

• Collecting a certification that the entity is neither excluded nor disqualified. Because a Federal certification form is no longer available, the grantee or sub-grantee electing this must devise its own.

• Including a clause to this effect in the sub-grant agreement and in any procurement contract expected to equal or exceed $25,000, awarded by the grantee or a sub-grantee under its grant or sub-grant.

(b) As a condition of this award, the grantee will ensure that all sub-grantees are informed and comply with the requirements of 2 CFR part 180, subpart C.

(c) The grantee agrees to comply with the requirements of 2 CFR part 180.335, and will provide notification to FNS if the organization or principal officials:

• Are presently excluded or disqualified;

• Have been convicted within the preceding 3 years of any offenses listed at 2 CFR part 180.800(a), including: (1) Commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public or private agreement or transaction; (2) Violation of Federal or State antitrust statutes, including those proscribing price fixing between competitors, allocation of customers between competitors, and bid rigging; (3) Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, receiving stolen property, making false claims, or obstruction of justice; or (4) Commission of any other offense indicating a lack of business integrity or business honesty that seriously and directly affects your present responsibility;

• Are presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any offense listed at 2 CFR part 800(a); or

• Have had a transaction (Federal, State or local) terminated within the preceding 3 years for cause or default.

Reporting Sub-award and Executive Compensation Information 2 CFR Part 170

The Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Public Law 109–282), as amended by Section 6202 of Public Law 110–252 requires primary grantees of Federal grants and cooperative agreements to report information on sub-grantee obligations and executive compensation. FFATA promotes open government by enhancing the Federal Government’s accountability for its stewardship of public resources. This is accomplished by making Government information, particularly information on Federal spending, accessible to the general public.

Primary grantees, including State agencies, are required to report actions taken on or after October 1, 2010, that obligates $25,000 or more in Federal grant funds to first- tier sub-grantees. This information must be reported in the government-wide FFATA Sub-Award Reporting System (FSRS). In order to access FSRS a current SAM registration is required. A primary grantee and first-tier sub-grantees must also report total compensation for each of its five most-highly compensated executives. Every primary and first-tier grantee must obtain a DUNS number prior to being eligible to receive a grant or sub-grant award. Additional information will be provided to grant recipients upon award.

Duncan Hunter National Defense Authorization Act of Fiscal Year 2009, Public Law 110-417

Section 872 of this Act requires the development and maintenance of a Federal Government information system that contains specific information on the integrity and performance of covered Federal agency contractors and grantees. The Federal Awardee Performance and Integrity Information System (FAPIIS) was developed to address these requirements. FAPIIS contains integrity and performance information from the Contractor Performance Assessment Reporting System, information from the SAM database, and suspension and debarment information from the SAM. FNS will review and consider any information about the applicant reflected in FAPIIS when making a judgment about whether an applicant is qualified to receive an award.

Freedom of Information Act (FOIA) Requests

The Freedom of Information ACT (FOIA), 5 U.S.C. 552, provides individuals with a right to access records in the possession of the Federal Government. The Government may withhold information pursuant to the nine exemptions and the three exclusions contained in the Act.

Application packages submitted in response to this grant solicitation may be subject to FOIA requests by interested parties. In response to these requests, FNS will comply with all applicable laws and regulations, including departmental regulations.

FNS will forward a Business Submitter Notice to the requested applicant’s point-of-contact. Applicants will need to review requested materials and submit any recommendations within 15 days from the date of FNS notification. FNS will redact Personally Identifiable Information (PII).

For additional information on the Freedom of Information (FOIA) process, please contact Jennifer Weatherly, FNS Freedom of Information Act officer at [email protected].

CODE OF FEDERAL REGULATIONS AND OTHER GOVERNMENT REQUIREMENTS

This grant will be awarded and administered in accordance with the following regulations 2 Code of Federal Regulations (CFR), Subtitle A, Chapter II. Any Federal laws, regulations, or USDA directives released after this RFA is posted will be implemented as instructed.

Government-wide Regulations

• 2 CFR Part 25: “Universal Identifier and System for Award Management”

• 2 CFR Part 170: “Reporting Sub-award and Executive Compensation Information”

• 2 CFR Part 175: “Award Term for Trafficking in Persons”

• 2 CFR Part 180: “OMB Guidelines to Agencies on Government-wide Debarment and Suspension (Non-Procurement)”

• 2 CFR Part 200: “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards”

• 2 CFR Part 400: USDA’s implementing regulation of 2 CFR Part 200 “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards”

• 2 CFR Part 415: USDA “General Program Administrative Regulations”

• 2 CFR Part 416: USDA “General Program Administrative Regulations for Grants and Cooperative Agreements to State and Local Governments”

• 2 CFR Part 417: USDA “Non-Procurement Debarment and Suspension”

• 2 CFR Part 418 USDA “New Restrictions on Lobbying

• 2 CFR Part 421: USDA “Requirements for Drug-Free Workplace (Financial Assistance)”

• 41 U.S.C. Section 22 “Interest of Member of Congress”

• Freedom of Information Act (FOIA). Public access to Federal Financial Assistance records shall not be limited, except when such records must be kept confidential and would have been excepted from disclosure pursuant to the “Freedom of Information” regulation (5 U.S.C. 552)

FINANCIAL REPORTING

The award recipient will be required to enter the SF-425, Financial Status Report data into the FNS Food Program Reporting System (FPRS) on a quarterly basis. In order to access FPRS, the grant recipient must obtain USDA e-authentication certification and access to FPRS. More detailed instructions for reporting will be included in the FNS Federal financial assistance award package.

PROGRESS REPORTING

The recipient will be responsible for managing and monitoring the progress of the grant project activities and performance. The award document will indicate the reporting schedule for submitting project performance/progress reports to FNS. The recipient is be required to submit performance/progress reports to FNS. Any additional reporting requirements will be identified in the award terms and conditions, including results of the grant project.

Full Grant Performance Period, Reporting & Meeting Attendance

Performance Period

The period of performance for the cooperative agreement shall be from the date of the award through xx, xx. All expenditures for authorized activities for the project (other than those for the final reports and FY 202X meeting and presentation) must be incurred by xx, xx. The final project and financial reports are due to FNS by xx, xx and all expenditures associated with the final report must be incurred xx xx. The only allowable expenditures on or after January 1, xx are those associated with preparation for attendance and presentation at the FNS-sponsored FY xx WIC Special Project Grant annual meeting, filing the associated expenditure reports and grant close-out. See Reporting and Meeting Requirements below for more information.

Reporting Requirements

Quarterly Progress Reports: A signed electronic file of the Quarterly Progress Report shall be submitted to the FNS Grants Officer (see below for contact information). The first report should reflect progress up to the end of the first fiscal quarter after the effective date of the Grant Agreement. At a minimum all Quarterly Progress Reports should include:

• Narrative description of the project’s progress, tasks completed, and roadblocks or problems.

• Identification of tasks or activities initiated, or completed, from proposed timeline with a description and rationale for deviations.

• For each major task, a description of activities performed or completed during the quarter.

• Identification and description of any major problems or delays encountered, with a discussion of how they will be resolved and/or how they may impact the schedule, outcome measures, budget, or the grantee’s ability to utilize funds within the specified time period.

• A description of key tasks and activities planned for the upcoming quarter.

• Any other pertinent information, which may include deliverables.

The recipient may be required to submit performance/progress reports to FNS using SF-PPR, Periodic Progress Report. Any additional reporting requirements will be identified in the award terms and conditions.

Final Project Report: An original and electronic copy of the Final Report shall be submitted to the FNS Grants Officer by xx, xx. This report shall contain a project summary including, but not limited to, a full description of implementation, evaluation approach, results of evaluation, impact, lessons learned, future implications within the State agency, and information on how the project will be sustained. In instances where there is a lead State agency involved, the lead State agency shall compile the results from all funded State agencies into a single report and submit it to the FNS Grant Officer. The final report should be accompanied by copies of materials developed by and used in the project (e.g., notices, brochures, instructions, lesson plans, software, press releases, and data collection instruments).

Quarterly Financial Reports: Grantees will electronically enter their quarterly and final financial status reports (SF-425) into the FNS Food Programs Reporting System (FPRS). This report must be certified by the Recipient's chief fiscal officer or an officer of comparable rank. Final reporting requirements and instructions will be provided to all awarded grantees.

Final Close-Out Financial Report: As stated above, the grantees are expected to enter the final financial status report (SF-425) into the FNS Food Programs Reporting System (FPRS) electronically, unless otherwise notified. The grantee shall enter its SF-425 data within 90 days of the expiration date of the grant agreement. This report must be certified by the grantee’s chief fiscal officer or an officer of comparable rank.

In an effort to maintain the integrity of these funds, FNS will continually monitor the expenditures and will work with the grantees to recover any funds that cannot be obligated by the grant expiration date of xx,xx. Funds not obligated within the cooperative agreement period must be returned to FNS by xx,xx.

Attendance at Meetings

State agencies awarded Full Grant funding will interact with other grantees and FNS staff on a regular basis to share project information. To that end, FNS hosts annual WIC Special Project Grant Meetings through the course of the projects. The grantee shall send two representatives (one representative must be from the WIC State Agency) to four meetings at FNS headquarters as specified below:

• An annual meeting of all grantees in the first year of the grant.

• An annual meeting of all grantees in the second year of the grant.

• An annual meeting of all grantees in the third (and final) year of the grant project.

• A final meeting within 9 months of completion of the project (i.e., xx 202X to present project findings to FNS.

Mini Grant Performance Period, Reporting & Meeting Attendance

The period of performance for the cooperative agreement shall be from the date of the award through xx, 20XX. All expenditures for authorized activities for the project (other than those for the final reports and FY 20XX meeting and presentation) must be incurred by xx, 20XX. The final project and financial reports are due to FNS by xx, 20XX and all expenditures associated with the final report must be incurred by xx, 20XX. The only allowable expenditures on or after xx, 20XX are those associated with preparation for attendance and presentation at the FNS-sponsored 20XX WIC Special Project Grant annual meeting, filing the associated expenditure reports and grant close-out. See Reporting and Meeting Requirements below for more information.

Reporting Requirements

Quarterly Progress Reports: A signed electronic file of the Quarterly Progress Report shall be submitted to the FNS Grants Officer (see below for contact information). The first report should reflect progress up to the end of the first quarter after the effective date of the Grant Agreement. At a minimum all Quarterly Progress Reports should include:

• A narrative description of the project’s progress, tasks completed, and roadblocks or problems.

• Identification of tasks or activities initiated, or completed, from proposed timeline with a description and rationale for deviations.

• For each major task, a description of activities performed or completed during the quarter.

• Identification and description of any major problems or delays encountered, with a discussion of how they will be resolved and/or how they may impact the schedule, outcome measures, budget, or the grantee’s ability to utilize funds within the specified time period.

• A description of key tasks and activities planned for the upcoming quarter.

• A participation report with data elements agreed to with FNS.

• Any other pertinent information, which may include deliverables.

The recipient may be required to submit performance/progress reports to FNS using SF-PPR, Periodic Progress Report. Any additional reporting requirements will be identified in the award terms and conditions, including results of the grant project.

Final Project Report: An original and electronic copy of the Final Report shall be submitted to the FNS Grants Officer by xx, 2019. This report shall contain a project summary including, but not limited to, a full description of implementation, evaluation approach, results of evaluation, impact, lessons learned, future implications within the State agency, and information on how the project will be sustained. In addition, all materials developed as a result of the grant funding shall be submitted with the Final Report. In instances where there is a lead State agency involved, the lead State agency shall compile the results from all funded State agencies into a single report and submit it to FNS. The final report should be accompanied by copies of materials developed by and used in the project (e.g., notices, brochures, instructions, lesson plans, software, press releases, and data collection instruments).

FNS Grants Officer:

XXXX XXXXX, Grants Officer

Grants and Fiscal Policy Division

U.S. Department of Agriculture, FNS

3101 Park Center Drive, Room 740

Alexandria, VA 22302

E-mail: [email protected]

Quarterly Financial Reports: Grantees will electronically enter their quarterly and final financial status reports (SF-425) into the FNS Food Programs Reporting System (FPRS). This report must be certified by the Recipient's chief fiscal officer or an officer of comparable rank. Final reporting requirements and instructions will be provided to all awarded grantees.

Final Close-Out Financial Report: As stated above, the grantees are expected to electronically enter the final financial status report (SF-425) into the FNS Food Programs Reporting System (FPRS), unless otherwise notified. The grantee shall enter its SF-425 data within 90 days of the expiration date of the grant agreement. This report must be certified by the grantee’s chief fiscal officer or an officer of comparable rank.

In an effort to maintain the integrity of these funds, FNS will continually monitor the expenditures and will work with the grantees to recover any funds that cannot be obligated by the grant expiration date of xx, 20XX. Funds not obligated within the cooperative agreement period must be returned to FNS by xx, 20XX.

Attendance at Meetings

State agencies awarded Mini Grant funding will interact with other grantees and FNS staff on a regular basis to share project information. FNS will host a WIC Special Project Grant Meeting after the Mini Grant projects have been completed. The grantee shall send one WIC State Agency representative to one meeting at FNS Headquarters in 2019 to present its findings.

General Terms and Conditions of the award may be obtained electronically. Please contact the FNS Grants Officer at:

XXXX XXXX, Grants Officer

Grants and Fiscal Policy Division

U.S. Department of Agriculture, FNS

3101 Park Center Drive, Room 740

Alexandria, VA 22302

E-mail: [email protected]

7. FEDERAL AWARDING AGENCY CONTACTS

For questions regarding this solicitation, please contact the FNS Grants Officer at:

XXXX XXXX, Grants Officer

Grants and Fiscal Policy Division

U.S. Department of Agriculture, FNS

3101 Park Center Drive, Room 740

Alexandria, VA 22302

E-mail: [email protected]

8. OTHER INFORMATION

FY 20XX WIC Special Project Grant Webinar

Within the first few weeks of the release of this RFA, FNS will host a webinar to review the RFA, the focus area, and provide guidance on how to apply for a grant. This webinar will be most helpful to those State agencies who have not applied for a Special Project Grant in recent years. Information on the webinar will be posted to the Announcements page of the FNS Partner Web: https://www.partnerweb.usda.gov/Lists/Announcements/shortlist.aspx.

Debriefing Requests

Non-selected applicants may request a debriefing to discuss the strengths and weaknesses of submitted proposals. This information may be useful when preparing future grant proposals. Additional information on debriefing requests will be forwarded to non-selected applicants.

List of Attachments

1. LETTER OF INTENT (optional)

2. APPLICATION CHECKLIST

3. TERMS AND CONDITIONS OF AWARD

4. BUDGET NARRATIVE CHECKLIST AND CERTIFICATION FORMS

   • BUDGET NARRATIVE CHECKLIST

   • CERTIFICATION REGARDING LOBBYING

   • DISCLOSURE OF LOBBYING ACTIVITIES

5. GRANT PROGRAM ACCOUNTING SYSTEM & FINANCIAL CAPABILITY QUESTIONNAIRE

ATTACHMENT A

LETTER OF INTENT

If you intend to submit an application for a Full or Mini WIC Special Grant, please complete the section below and return this form by xx, 20XX. This intent does not obligate a State agency in any way, but will provide useful information to us as we prepare for the review and selection process. The intent may be e-mailed or faxed. Thank you for your interest. Please submit your Letter of Intent to:

Kimberly Shields, Grants Officer

Grants and Fiscal Policy Division

U.S. Department of Agriculture, FNS

3101 Park Center Drive, Room 740

Alexandria, VA 22302

E-mail: [email protected]

20XX WIC Special Project Grant

Intent to Submit an Application

Applicant (State agency name and address):

Project Director or Contact Person:

Telephone:

E-mail:

Applying for (check one):

	Full Grant
	Mini Grant

ATTACHMENT B

APPLICATION CHECKLIST

PROPOSAL REQUIREMENTS

_____ Format:

_____ Full Grant - Up to 25 pages excluding up to 15 pages of appendices (No page limit to resumes)

_____ Mini Grant – Up to 12 pages excluding up to 8 pages of appendices (No page limit to resumes)

_____ Font size no smaller than 12 point

_____ 8 ½” X 11” paper

_____ Single-sided

_____ Single-spaced

_____ I. Introductory Material

_____ A. Cover Letter

_____ B. Title Page with Summary and Single Point of Contact

_____ C. Table of Contents

_____ II. Abstract

_____ III. Project Design and Implementation

_____ A. Need for Project

_____ B. Goals

_____ C. Objectives

_____ D. Tasks

_____ E. Environnent

_____ F. Letter of Support

_____ IV. Project Evaluation

_____ A. Type of Evaluation

_____ B. Research Design

_____ V. Sustainability and Transferability

_____ A. Sustainability

_____ B. Transferability

_____ VI. Key Personnel

_____ VII. Management and Budget Plan

_____ A. Management Plans

_____ B. Budget and Budget Justification

_____ VIII. Budget Forms

ATTACHMENT B (continued)

____ IX. Appendices (15 page maximum)

_____ A. Resumes and vitae for key personnel

_____ B. Letters of commitment from supervisors of key personnel

_____ C. Job descriptions for key personnel that must be hired

_____D. Copies of agreements and Memoranda of Understanding with local WIC clinics and/or partner agencies

_____ E. Any other supporting documentation

REQUIRED FORMS

_____ Standard Form 424, Application for Federal Assistance

_____ Standard Form 424A, Budget Summary

_____ Standard Form 424B, Assurances - Non-Construction Programs

_____ SF-LLL Disclosure of Lobbying Activities

The above listed forms are at the USDA Forms site: http://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms.

CERTIFICATION FORMS (see Attachment D)

_____ Certification Regarding Lobbying - Contracts, Grants, Loans, and Cooperative Agreements

OBTAIN A DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER

_____ Registered and obtained a Data Universal Numbering System (DUNS) number.

SYSTEM FOR AWARD MANAGEMENT (SAM) REGISTRY REGISTRATION

_____ Registered in the Federal Government’s System for Award Management (SAM).

ATTACHMENT C

TERMS AND CONDITIONS OF AWARD

The Agency awarded the grant must be conducting the Women, Infants, and Children (WIC) Special Project Grant as authorized under Public Law 111-296. This grant will be awarded and administered in accordance with the applicable regulations and OMB grant circulars, as described below. Copies of these documents are available from the Grants Officer upon request.

Code of Federal Regulation Cost Principles:

40 CFR Part 31.34 - Copyrights

The Federal awarding agency reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for Federal Government purposes:

(a) The copyright in any work developed under a grant, sub-grant, or contract under a grant or sub-grant; and

(b) Any rights of copyright to which a grantee, sub-grantee or a contractor purchases ownership with grant support.

ATTACHMENT D

BUDGET NARRATIVE CHEKCLIST AND FORMS

Budget Narrative Checklist – This checklist will assist you in completing the budget narrative portion of the application. Please review the checklist to ensure the items below are addressed in the budget narrative. NOTE: The proposal project description (statement of work) must capture the bona fide need. The budget and budget narrative must be in line with the proposal project description. FNS reserves the right to request information not clearly addressed.

	YES	NO
Personnel
Did you include all key employees paid for by this grant under this heading?
Are employees of the applicant’s organization identified by name and position title?
Did you reflect the current yearly salary as a percentage of time to be devoted to the project?
Fringe Benefits
Did you include your organization’s fringe benefit amount along with the basis for the computation?
Did you list the type of fringe benefits to be covered with Federal funds?
Travel
Are travel expenses itemized? For example origination/destination points, number and purpose of trips, number of staff traveling, mode of transportation and cost of each trip.
Are the Attendee Objectives and travel justifications included in the narrative?
Is the basis for the lodging estimates identified in the budget? For example include excerpt from travel regulations.
Equipment
Is the need for the equipment justified in the narrative?
Are the types of equipment, unit costs, and the number of items to be purchased listed in the budget?
Is the basis for the cost per item or other basis of computation stated in the budget?
Supplies
Are the types of supplies, unit costs, and the number of items to be purchased reflected in the budget?
Is the basis for the costs per item or other basis of computation stated?
Contractual: (FNS reserve the right to request information on all contractual awards and associated costs after the contract is awarded.)
Has the bona fide need been clearly identified in the project description to justify the cost for a contract or sub-grant expense(s) shown on the budget?
A justification for all Sole-source contracts must be provided in the budget narrative prior to approving this identified cost.
Other
Consultant Services. – Has the bona fide need been clearly identified in the project description to justify the cost shown on the budget? The following information must be provided in the justification: description of service, the consultant’s name and an itemized list of all direct cost and fees, number of personnel including the position title (specialty and specialized qualifications as appropriate to the costs), Number of estimated hours X hourly wages, and all expenses and fees directly related to the proposed services to be rendered to the project.
For all other line items listed under the “Other” heading, list all items to be covered under this heading along with the methodology on how the applicant derived the costs to be charged to the program.
Indirect Costs
Is the amount requested based upon a rate approved by a Federal Agency? If yes, a copy of the negotiated rate agreement must be provided along with the application.
If the applicant does not have a negotiated indirect cost agreement approved by a cognizant federal agency used to determine the base rate of these costs; the application should show this cost as a direct cost to the budget.

FOR GRANT APPLICANT USE ONLY. DO NOT RETURN THIS FORM WITH THE APPLICATION

ATTACHMENT D (continued)

CERTIFICATION REGARDING LOBBYING

CERTIFICATION FOR CONTRACTS, GRANTS, AND COOPERATIVE AGREEMENTS

The undersigned certifies, to the best of his or her knowledge and belief, that:

1. No Federal appropriated-funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal-appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL,  Disclosure Form to Report Lobbying,  in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including sub-contracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

By Date:

_{(Signature of Official [Executive Director] Authorized to Sign Application)}

By Date:

(Signature of Official (Chief Financial Officer) Authorized to Sign Application)

For

Name of Grantee

Title of Grant Program

ATTACHMENT D (continued)

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046

(See reverse for public burden disclosure)

Type of Federal Action: a. contract b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance	Status of Federal Action: a. bid/offer/application b. initial award c. post-award		Report Type: a. initial filing b. material change For material change only: Year _______ quarter _______ Date of last report___________
Name and Address of Reporting Entity: Prime Subawardee Tier______, if known: Congressional District, if known:		If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, if known:
6. Federal Department/Agency:		7. Federal Program Name/Description: Federal Program Name/Description: CFDA Number, if applicable: __________________
8. Federal Action Number, if known:		9. Award Amount, if known: Award Amount, if known: $
10. a. Name and Address of Lobbying Registrant (if individual, last name, first name, MI):		Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI):
11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.		Signature: ______________________________________ Print Name:_____________________________________ Title:__________________________________________ Telephone No.: _________________ Date: ___________
Federal Use Only				Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

ATTACHMENT D (continued)

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 within 30 days of 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. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. 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 follow-up 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 sub-award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Sub-awards include but are not limited to subcontracts, sub-grants 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: Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency]. Include 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 entity engaged by the

reporting entity identified in item 4 to influence the covered Federal action.

2. 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.

Public reporting burden for this collection of information is estimated to average 30 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, D.C. 20503.

ATTACHMENT E

Grant Program Accounting System & Financial Capability Questionnaire

Purpose

Recipients of Federal funds must maintain adequate accounting systems that meet the criteria outlined in 2 CFR §200.302 Standards for Financial and Program Management. The responses to this questionnaire are used to assist in the Food and Nutrition Service Agency’s (FNS) evaluation of your accounting system to ensure the adequate, appropriate, and transparent use of Federal funds. Failure to comply with the criteria outlined in the regulations above may preclude your organization from receiving an award. This form applies to FNS’ competitive and noncompetitive grant programs. Please return this questionnaire with your application package to us.

Organization Information

Legal Organization Name:

D-U-Ns Number:

Financial Stability and Quality of ManagEment Systems

Requirement	Yes	No
Has your organization received a Federal award within the past 3 years?	☐	☐
Does your organization utilize accounting software to manage your financial records?	☐	☐
Does your accounting system identify the receipt and expenditure of program funds separately for each grant?	☐	☐
Does your organization have a dedicated individual responsible for monitoring organizational funds, such as an accountant or a finance manager?	☐	☐
Does your organization separate the duties for staff handling the approval of transactions and the recording and payment of funds?	☐	☐
Does your organization have the ability to specifically identify and allocate employee effort to an applicable program?	☐	☐
Does your organization have a property /inventory management system in place to track location and value of equipment purchased under the award?	☐	☐

Audit Reports and Findings

Requirement		Yes	No
Has your organization been audited within the last 5 fiscal years? (If the answer is “Yes” and this report was issued under the Single Audit Act please note this in the box below marked “Additional Information” and if not issued under the “Single Audit Act”, please attach a copy or provide a link to the audit report in the Hyperlink space below).		☐	☐
If your organization has been audited within the last 5 fiscal years, was there a “Qualified Opinion” or an “Adverse Opinion”?		☐	☐
If your organization has been audited within the last 5 fiscal years, was there a “Material Weakness” disclosed?		☐	☐
If your organization has been audited within the last 5 fiscal years, was there a “Significant Deficiency” disclosed?		☐	☐
Hyperlink (if available):
Additional information including expanding on responses in previous sections:

Applicant Certification

I certify that the above information is complete and correct to the best of my knowledge.

Authorized Representative’s Signature and Date
Name:
Phone:
Email:

54

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