Attachments 1 - 6

Pool Safely Grant Program Application

PSGP Information Collection Instruments

Attachments 1 - 6

OMB: 3041-0210

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Attachment 1: Project Narrative

This section provides a comprehensive framework and description of all aspects of the applicant’s proposed project. The narrative should be succinct, self-explanatory, and well organized so that reviewers can understand the proposed project. Upload the Project Narrative under Attachment 1.

The narrative must be submitted in the following format:

  • Line Spacing: single-spaced, 1.0

  • Font size: 12 point

  • Paper size: 8.5 by 11 inches

  • Page margin size: 1 inch.

Use the section headings below for the project narrative and address activities to be conducted over the entire project period in the order listed below:

    • Table of Contents

Insert a table of contents with section headers and corresponding page numbers.

    • Introduction

Provide an introduction that aids reviewers in understanding the community that will be helped by the proposed project.

Applicants must:

      • describe the local community or region to be served, citing relevant demographic data and data related to child drowning and entrapment in swimming pools and spas. A description of the population to be served should include the estimated size of the population, as well as socio-cultural factors. Compare local and/or state data to federal data, where possible, to highlight the specific needs of the community or the region to be served. Describe the enforcement and education needs of the community as they relate to protecting children from drowning and entrapment in pools and spas.

      • describe any current and past efforts to address these needs, explain whether the efforts were successful, and how success was determined.

      • show how the community’s needs relate to the proposed project objectives set forth in the work plan (see next section).

      • identify any factors present in the community that may make enforcement, training, and education authorized under the grant program more difficult (e.g., language, transient populations, ability to inspect public versus private pools).

FUNDING PREFERENCE: To request the optional “Funding Preference,” Applicants must include data in the Introduction under a separate sub-heading. The “Funding Preference” must provide accurate and reliable data demonstrating that the number of incidents involving child drownings, nonfatal submersions, and drain entrapments in the jurisdiction, relative to the applicable population, significantly exceeds comparable national statistics during comparable periods. If not requesting the “Funding Preference,” this portion may be omitted.

    • Work Plan

The applicant’s work plan provides a framework and describes all aspects of the proposed project. The work plan should be succinct, self-explanatory, and well organized to aid reviewers’ understanding of the proposed project.

Use of a tabular format, with rows and columns to display this information, is strongly encouraged for effective organization of the work plan information. The table should include, and clearly illustrate, the project’s goals, objectives, strategies, activities, timeframes assigned for work plan execution during project implementation (including completion dates for each activity), and individuals, organizational representatives responsible for carrying out each work plan activity.

In this section, describe the applicant’s scope of work for the proposed project under this funding opportunity. The proposed project must be consistent with the required program purposes defined under Section 1405(d) of the VGB Act.

In addition, the scope of work must:

      • provide clear project objectives that align with the enforcement and educational requirements for use of grant funds. The project objectives must be S.M.A.R.T. i.e., specific, measurable, achievable, relevant, and time-bound.

      • for each project objective, describe the specific activities to be undertaken, and describe how to ensure successful implementation of the proposed project. Each of the activities should be described in detail (i.e., who, what, how, where, and when).

      • appropriately incorporate the free CPSC resources of the Pool Safely education campaign. This will ensure accuracy and consistency of training and education activities across all grant recipients.

Identify plans to collaborate with other stakeholders in planning, designing, and implementing the project (e.g., other state, local, or municipal entities; service organizations; pool construction, installation, and service companies; pool owners and operators; professional organizations; local businesses; school systems; parent/teacher organizations; civic organizations; local public officials; and the media). Collaborations with other stakeholders are encouraged, but collaborations are not a required element of an awardee’s project. Describe the extent to which collaborators reflect the cultural, racial, linguistic, and geographic diversity of the populations and communities served.

    • Project Evaluation Plan

Provide a project evaluation plan, including performance measures.

The project evaluation plan must:

      • explain how the applicant will gather data relevant to progress in meeting each of the goals and objectives of the grant program, and

      • identify the activities the applicant expects to complete during the project period that are relevant to the overall impact of the project. For each identified activity, the plan should also describe the outputs and outcomes (e.g., how many participants, how many materials distributed, what is the change in knowledge), and performance benchmarks for measuring progress of each activity and for measuring project outputs/outcomes.


If CPSC funds a proposed project, grantees must submit a final self-evaluation of the project’s goals and objectives based on the grantee’s project evaluation plan. The project evaluation plan will be incorporated into the final report under the grant award.

Attachment 2: Budget Table/ Narrative

To ensure that project budgets adhere to VGB Act requirements, a project-specific line-item budget must be submitted. Submit the budget narrative in table format, providing a detailed breakout of costs organized under form SF- 424A’s object class categories (e.g., personnel, fringe benefits, supplies, other). Upload the budget narrative under Attachment 2. Indirect Cost Rates for the current year from the cognizant federal agency should be included under Attachment 6.

The budget narrative must:

  • identify any resources that will be used to contribute to the overall success of the proposed project;

  • include a narrative for each budget line item and explain how the costs relate back to the scope of work described in the Project Narrative and the Schedule; and

  • identify clearly which initiatives and costs support the enforcement initiatives and which support the education initiatives (including all administrative expenses).


The amount requested on form SF-424 and the amount in the budget narrative must match.

Note: Because at least 25 percent of the total award must be spent on training and hiring of enforcement personnel and enforcement activities, all activities should either be identified clearly as either enforcement-related (i.e., expenses related to training and hiring of enforcement personnel and expenses related to enforcement activities), or education-related within the budget narrative.


Attachment 3: Schedule

Provide a descriptive and realistic schedule that fully implements the project within the 2-year period.

The schedule must:

  • include milestones aligned with the project goals,

  • indicate when each milestone will occur, and

  • indicate the person(s) responsible for managing each activity. Applicants should include an organizational chart that shows the placement of the project within the state or local agency’s organizational structure.


Upload the schedule and organizational chart under Attachment 3.

Attachment 4: Staffing Plan

Provide a detailed staffing plan that identifies key staff responsible for managing and implementing the project. Upload the staffing plan under Attachment 4.

The staffing plan must:

  • identify the Program Director and any key staff who will manage or participate in key activities funded by the grant and whether the staff exists, to be hired, or to be engaged under contractual arrangements.

  • identify any staff who will monitor contractors’ use of funds or provision of services (if applicable).

  • describe the qualifications of each staff position (including the Program Director) and how those qualifications relate to the proposed project. In the description of qualifications, include the relevant education, training, experience, and expertise, of key personnel, in addition to language fluency and experience working with the populations the proposed project will serve.

  • describe each staff position, including the roles and responsibilities under the proposed project to be funded by the grant.

  • for each staff position, note all related sources of funding and the amount of time each identified individual will be reasonably expected to devote to the project (expressed as a percentage of a full-time employee).

CPSC encourages applicants to supply this information in a table format. Personnel are to be listed by position title; specify the name of the individual for each position or title, or note whether the position is vacant.

Attachment 5: Copy of State or Local Pool and Spa Safety Law and Explanation of Eligibility of Law for VGB Act Grants

Applicants must demonstrate that their jurisdiction has enacted or amended state or local law(s) that meet the minimum state law requirements specified in Section 1406 of the VGB Act (15 U.S.C. § 8005). The applicant must explain how the law(s) meet each of the requirements set forth in Section 1406(a)(1) of the VGB Act and how the applicant provides for enforcement of the law(s).


Attachment 6: Indirect Cost Rate (as applicable)

Applicants that include indirect costs based on a Negotiated Indirect Cost Rate Agreement (NICRA) in the budget must provide the NICRA for the current year from the cognizant federal agency substantiating indirect costs that may be reimbursed as permissible administrative costs under the VGBA. Upload the NICRA from the cognizant agency as Attachment 6.







File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorGillham, Cynthia
File Modified0000-00-00
File Created2025-07-25

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