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Community involvement is an important part of the Environmental Pro-
tection Agency's (EPA) efforts under the Superfund Program to respond
to risks associated with the nation's worst hazardous waste sites. The
Technical Assistance Grant (TAG) Program provides funds for qualified
citizens' groups affected by a Superfund site to hire independent techni-
cal advisors to help interpret and comment on site-related information.
This booklet explains the basic program requirements that your group
must meet to be eligible for a TAG and to successfully complete a TAG
application. The TAG Program is governed by certain regulations,
which are paraphrased throughout this booklet. It is important that you
clearly understand these requirements and how they apply to the TAG
Program. If you wish, you may refer to the full text, recorded in the Code
of Federal Regulations (CFR), Parts 30,33, and 35, subpart M. The full text
is available from your library and your Regional TAG Coordinator.
Milestones in the
Superfund Process
The Comprehensive Environmental Response, Compensation, and Li-
ability Act of 1980 (CERCLA), commonly known as "Superfund," pro-
vides the nation with its principal means of cleaning up hazardous waste
sites that EPA has placed, or proposes to place, on the National Priorities
List (NPL). The NPL is the list of the nation's most serious hazardous
waste sites. Milestones in the cleanup process include the following:
Upon identification of a potentially
contaminated site (discovery), EPA
determines whether the site poses
an immediate threat to human
health or the environment that
warrants immediate "removal"
action. If a contamination problem
exists but does not pose immediate
danger to the community, EPA
conducts a Preliminary Assess-
ment/Site Inspection (PA/SI) to
determine whether the site should
be placed on the NPL.
Once a site is listed, EPA conducts
detailed technical studies on the
Discovery
PA/SI
RI/FS"
ROD ' *
RD/RA
Completion
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nature and extent of the waste at the site. This examination of the
site contamination and the identification of possible remedies*
called a Remedial Investigation/Feasibility Study (RI/FS). This
study outlines alternative methods of cleanup available and recom-
mends the most suitable one. The Record of Decision (ROD), which
is based on the documents that make up the RI/FS, identifies and
explains the selected remedy.
After signing a ROD, EPA begins the Remedial Design (RD) phase,
adapting the remedy chosen to site-specific conditions. During
Remedial Action (RA), EPA cleans up the site using the selected
remedy. Operation and Maintenance activities may continue at the
site for many years after the initial cleanup is completed.
TAGs are available at any time during the site cleanup process, but
most opportunities for effective community involvement exist during
the RI/FS (sometimes called the "pre-ROD stage"). This is the stage
when most decisions about how to respond to site contamination are
made and when your technical advisor will be most useful to the mem-
bers of your group.
BEGINNING THE PROCESS
The TAG process begins when a group of individuals affected by a Super-
fund site listed, or proposed for listing, on the NPL submits either a Let-
ter of Intent (LOI) or a completed TAG
application to its EPA Regional Office.
EPA then notifies the community as a
whole that an application is or will
shortly be under review, giving other
potential applicants 30 days to contact
the original applicant to form a coali-
tion and submit a single application.
A Pre-Application
Checklist
Is the site listed, or pro-
posed for listing, on the
NPL?
Has EPA's response
- action begun?
Are you a group of resf-
dents or property own-
ers who could be
affected by the site?
Have you contacted
your Regional TAG
Coordinator?
Since only one TAG may be awarded
for a site, EPA encourages groups to
consolidate in order to provide techni-
cal assistance to the most widely repre-
sentative group of individuals affected
by a site. If groups are unsuccessful in
forming a coalition, each has an addi-
tional 30 days to prepare its own appli-
cation.
This booklet is intended for groups of
potentially affected individuals who
have decided to apply for a TAG and
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who may have sent EPA an LOI stating this. If you have not sent in
an LOI, you may do so, although a completed application also serves
that purpose.
To make the best use of your time, you should be certain that your group
is eligible to receive a TAG before beginning the application process. If
you are unsure, you should contact your Regional TAG Coordinator be-
fore proceeding (see inside cover).
Your group is eligible to receive a TAG if it is a group of individuals po-
tentially affected by a hazardous waste site that is either listed or pro-
posed for listing on the NPL. In addition, EPA must have started its re-
sponse action at the site. The response action begins when EPA sets
aside funds for site cleanup. Your Regional TAG Coordinator can tell
you whether the response action has begun.
While someone representing an ineligible group cannot belong to an eli-
gible group, that person acting as an "affected individual" may be a
member. For example, your mayor could not be a member of your
group if he/she did so as a representative of your local government, but
could participate as a private individual if he/she was affected by the
site. Contact your Regional TAG Coordinator for help in determining
your group's eligibility.
Incorporating
To be eligible to receive a grant for a
site, your group must be incorporated
as a nonprofit organization for the pur-
pose of addressing that Superfund site.
Incorporation can protect the indi-
vidual members of your group from
potentially serious personal liability
problems. Incorporation costs are reim-
bursable with TAG funds if your group
receives a TAG.
If your group is already incorporated
for another purpose, it must be rein-
corporated for the purposes of the
TAG Program, unless you can show
that your group or group members
have been significantly involved with
issues related to the site. If your group
would be eligible except that it is not
1.-' Your grouplis «"> -
INELIGIBLE for a TAG
if it Is:
Potentially responsible
for contamination prob-
lems at the site.
An academic institution.
( * «,£ o'
A politics !subdivision
(such as a township or
municipality). -
?A group established or
sustained by govern-
mental entities, a PRP, .
or any ineligible entity.
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incorporated, you still may submit an application. However, if your group
is awarded the grant, you must be able to prove both of the following:
Your group has filed for incorporation by the time of the grant
award.
Your group has been incorporated by the time you submit your first
request for reimbursement.
By planning the incorporation process to coincide with the application
process, your group will avoid incurring incorporation costs until after
you find out if your application is approvable. Be sure to state this in
your application if this is what your group plans to do.
: ' ' ! I " ' I l|iil
Some groups find it desirable to apply for tax-exempt status at the same
time that they incorporate. When you have tax-exempt status, individu-
als can make tax-deductible cash donations to your group. TAG funds
may be used to cover the additional costs involved.
DEMONSTRATING YOUR GROUP'S CAPABILITIES """
As a TAG applicant, your group must demonstrate its capability to ade-
quately and responsibly manage the grant In general, you must demon-
__mmamssmim-!****&***i strate that your group has established, or
EPA will evaluate
your group's
ability to:
f^tMttMmaJi.Mi.f^tuffau^iaujiKm
Meet project
deadlines,
Maintain adequate
accounting and au-
diting procedures.'
Raise
contributions.
Comply with civil
rights and equal
1 employment laws.
has plans for establishing, reliable proce-
dures for managing a TAG.
MEETING YOUR FINANCBAl
REQUIREMENTS
As specified in the 1986 amendments to the
Superfund law, initial TAG awards are lim-
ited to $50,000 per site. In addition, these
amendments require recipient groups to
contribute, or "match," 20 percent of the to-
tal project costs.
Twenty Percent Matching Funds
Requirement
As part of -the TAG agreement with EPA,
m your group must provide 20 percent of the
total costs of the technical assistance
project. For example, your group must add $12,500 to match an EPA
grant of $50,000 (20 percent of the total project costs of $62,500). Twenty
percent may seem like a lot; however, in recognition of the value of your
group members' skills and time, the TAG Program allows you to count
the value of volunteered services and contributions of supplies toward
the required match, as well as cash that the group spends on products or
4
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services. Volunteered services and donated supplies used toward your
match are called "in-kind contributions."
In-Kind Contributions
In-kind contributions are non-cash contributions to the project. Examples
of in-kind contributions include:
Volunteered services/ such as:
A bookkeeper's maintenance of your group's financial records and
preparation of required financial reports.
An auditor's review of your group's financial records.
A lawyer's aid in drafting a contract for your technical advisor(s).
Your project manager's oversight of contracts.
A group member's efforts to produce a group newsletter.
The time spent by group representatives (such as Board Members)
attending site-related meetings.
Donated supplies, such as:
Use of equipment (such as a computer or copier) and office space.
Office supplies (such as paper and pencils).
Photocopying, printing, and postage.
Telephone calls.
Meeting space.
Other costs in your TAG application that are approved by EPA.
In-kind contributions must be documented in your records and approved
by your EPA Regional Office. Rates for volunteer services must be consis-
tent with rates in your community for
similar services, and may not include
fringe benefits, overhead, or profit.
Your Regional TAG Coordinator can
assist you in determining the eligibility
and value of in-kind contributions.
Waivers of the Matching Funds
Requirement
Because in-kind contributions can be
counted toward your group's 20 per-
cent match, EPA will waive all or part
of the matching funds requirement
only under unusual circumstances.
EPA can allow waivers only at sites
where the Record of Decision (ROD)
has not yet been signed for the last op-
erable unit at the site.
To request a waiver, include a written
statement describing your group's
reasons in your application package.
5
To obtain a waiver, you
must demonstrate that:
The full match would be
ah Unusual financial »
hardship {demonstrated
by'conditions such as be-
low-average income or a
high unemployment rate >
in your area). ., x -
Your group's good faith
effort at raising the match.
or in-kind contributions ^
has jailed. ,
The wajver is necessary
to ensure public partici-
pation in the sjte cleanup
decision. ' *
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The Administrative Cap
To ensure that TAG funds are used primarily for their intended pur-
posethe interpretation and communication of site-related technical
data to the affected communityadministrative costs, such as
recordkeeping and accounting activities, may comprise only 20 percent
of the total TAG budget. The total budget includes federal funds and
your group's matching share.
IDENTIFYING ELIGIBLE ACTIVITIES
Eligible activities are those that can be earned out with TAG funds.
Questions concerning activities suitable for technical assistance should be
directed to your Regional TAG Coordinator. The term "contractor" re-
fers to any people or companies you hire (enter into a contract with).
Eligible Activities
The purpose of a TAG is to assist groups in obtaining technical assistance
in interpreting site-related documents and other activities that would
contribute to the public's understanding of overall site conditions and
decisions. To obtain this assistance,
your group should hire a technical
advisor. The TAG project manager
or Board of Directors should pro-
vide direction and oversight of con-
tractors' activities.
Suitable technical advisor
activities include:
Reviewing/interpreting site-
related documents.
Meeting with you to explain
technical information.
Providing assistance to
your group in communicat-
ing the group's site-related
concerns to EPA.
Communicating the con-
tents of the technical
advisor's reports to the
community.
v* * ' * '
Participating in site visits to
gain a better understanding
of cleanup activities.
>,-,,.> i & ,*,
Traveling to meetings and
hearings directly related to
the situation at the^site.
Participating in health and
safety training.
The exhibit on page 7 suggests a
number of points in the cleanup
process when your technical
advisor's involvement may be par-
ticularly useful. When you fill out
the grant application, you will be
asked to estimate the amount of
document review time needed by
your technical advisor. You are en-
couraged to discuss with your Re-
gional TAG Coordinator projected
tasks for your advisor and how
these tasks may be affected by site-
specific circumstances.
Eligible activities also include hiring
someone with the necessary skills to
help your group manage the grant
(within the constraints of the 20 per-
cent cap on administrative costs).
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Tasks for Which a Technical Advssor May Be Useful
Removal:
Reviewing public documents generated during the removal
process.
Preliminary Assessment/Site Inspection:
Reviewing Preliminary Assessment/Site Investigation (PA/SI) data
that led to the site's listing.
Remedial Investigation/Feasibility Study:
Participating in informal meetings with your group, prior to the
Remedial Investigation/Feasibility Study (Rl/FS), to explain what
is known aboutthe nature of the problems atthe site based on the
PA/SI data.
Reviewing selected technical documents, including the Rl/FS
report, produced during the Rl/FS.
Participating in public meetings to help clarify information about
site conditions and how the Rl/FS will address these conditions.
Interpreting results of the Rl/FS report once it is availablefor public
review. Explaining the range of alternatives under consideration.
Identifying the differences among the remedial alternatives with
respect to the group's preferences.
Reviewing or assisting in preparing the group's public comments
on the Rl/FS report.
Explaining the lead and supporting agencies' recommended
remedial action (RA) presented in the proposed plan for the site.
Remedial Design/Remedial Action:
Explaining the lead and supporting agencies' remedial action
decision present in the Record of Decision (ROD) for the site.
Reviewing the remedial design (RD) to ensure that your group's
concerns are addressed.
Visiting the site vicinity periodically during the RA, if possible, to
observe the progress of construction activities and to provide a
technical update to the group members.
Reviewing the final inspection/certification report and final tech-
nical report because any concerns over construction activities
must be raised prior to EPA's acceptance of the completed project.
Operation and Maintenance:
Reviewing the operation and maintenance plan and close-out
reports for the group.
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Ineligible Activities
Grant funds may not be used to finance
the following activities:
Political and lobbying activities.
Any tuition or other expenses for
group members to attend training,
seminars, or courses.
Generation of new primary data,
such as well drilling and testing
(including split sampling).
Challenging final EPA decisions
(such as RODs), unless EPA has
formally reopened such a decision
for comment.
Any activities or expenditures for
group members' travel.
Litigation or underwriting legal
actions, such as paying attorneys or
technical advisors to participate in
any legal action or proceeding
regarding or affecting the site.
Activities inconsistent with the cost
principles stated in OMB Circular
A-122, "Cost Principles for Non-
Profit Organizations."
Although the above activities cannot be
funded with TAG funds, members of
your group may be able to undertake
them by using other funds (so long as those funds are not used to meet
the matching requirement).
Suitable grant
administrator
activities include:
ipmu^Mmnriiiii Ht^.immiittiimnw
Helping to'prepare the
"Solicitation" used to
hire your advisor.
Preparing solicitation
packages for prospec-
tive contractors.
Placing public notices.
Preparing contracts.
Preparing financial and/
progress reports.
Preparing amendments
and continuation appli-
cations.
u ^
Tracking expenses,
* J "V
Submitting payment
vouchers.
Taking meeting notes.
Acting as the group
contact with the EPA4 ^
Regional Office'.'
THE TAG APPLICATION >i*^*«**ii^ii.^r^, » -mmii»n
The following discussion provides a basic orientation to the structure,
organization, and timing of the application. In addition, it suggests
steps you should take before filling out the application.
)..:. ' i
Overview of the Application Forms
The application form required for the TAG Program is entitled, "Appli-
cation for Federal Assistance" [EPA Standard Form (SF) 424]. As the
name implies, it is a grant application form used for many grant pro-
grams besides the TAG Program. The basic application form consists of
four parts:
8 ''
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General Information, Signature, and Certification (SF 424).
Budget Information (SF 424A).
Assurances (SF 424B).
Project Narrative Statement (Applicant Qualifications and the
Statement of Work).
Your group also must complete a form entitled "Certification Regarding
Debarment, Suspension, and Other Responsibility Matters" (EPA Form
5700-49) if you are applying for a grant of $25,000 or more. This form
represents your group's assurance that it has not been disqualified from
engaging in transactions with the federal government.
To aid you in completing your application, step-by-step instructions and a
sample version specific to the TAG Program are available along with the
blank forms. If you have questions on the TAG Program requirements or
how to complete the forms, contact your Regional TAG Coordinator.
Consolidating
If you are aware of other groups in your community planning to apply
for a TAG at the same site, you are strongly encouraged to consolidate
your groups and applications into one. If there is more than one quali-
fied applicant and the groups cannot consolidate, EPA will award the
grant to the single most appropriate applicant, based on EPA's evalua-
tion of each application and any additional information requested from
the groups. Everyone benefits if groups form a coalition that most
broadly represents the affected community.
Planning and Scheduling Activities
Typically, a TAG is planned and awarded for a three-year budget pe-
riod. However, the cleanup process at Superfund sites generally takes
longer than three years. If you have funds left at the end of the first bud-
get period and wish to continue your involvement at the site, you can
submit a "continuation application" to EPA prior to the expiration of
that period. If, however, at the end of the first budget period, your
group is out of money and feels that it needs more money for informed
participation in site-related issues, you can apply for additional funds.
Getting Ready
Before filling out a TAG application, you
should contact the EPA Remedial Project Man-
ager for the site to obtain information about
the planned schedule for site activities. This
information will help you plan the tasks you
would like to have your technical advisor(s)
perform. Keep in mind, however, that site ac-
tivity schedules are subject to change.
Only one TAG
is available
at each
Superfund site
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,1 '
INTERGOVERNMENTAL REVIEW m****LmMi**m^*tm»i**»-*^iit
All grants are subject to intergovernmental review. This means that, if
the state requires it, you must provide it with an opportunity to review
your grant application so that your Governor can stay informed about
the variety of grants awarded within your state. State requirements re-
garding this review vary, so you should call your state's intergovern-
mental review contact to find out the procedure to foUow. Typically,
you will need to submit a copy of your grant application to that contact,
who will distribute it to interested reviewers. Reviewers may or may not
ask you to make minor changes in your
application if, for example, it affects state
programs. Your Regional TAG Coordina-
tor can give you the contact's name and
telephone number for your state.
States may require up to 60 days for the
intergovernmental review process. EPA
cannot process your application package
without evidence that you have submit-
ted the application to the state reviewers,
if necessary. EPA cannot award a grant
until the state has completed its intergovernmental review, as indicated
in Item 16 of your application form.
Determining state
requirements should
be one of the first
things you do in
preparing your
application.
SUBMITTING YOUR GRANT APPLICATION mm^mmmMmMmms^,^
Completed grant application packages must be submitted to the EPA Re-
gional Office overseeing cleanup activities at your site. You must submit
the original application package and two copies. The primary applica-
tion must have the original signature of your group's project manager
(the person your group authorizes to certify your group's compliance
with EPA's regulations).
EPA will review and evaluate each application received. You may be
asked to revise your application to clarify certain information or to ad-
equately demonstrate that you have complied with the regulations gov-
erning the TAG Program.
You should be aware that, in general, the information supplied by
groups is not considered confidential. When EPA receives a grant appli-
cation, the information on it becomes part of EPA's records and therefore
is subject to public release under the Freedom of Information Act (5
U.S.C. 552).
10
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To ensure that grants are awarded to the applicants most dkectly af-
fected by the site, EPA has developed a process to evaluate the strengths
and weaknesses of your application. EPA will review and score your ap-
plication using the five evaluation criteria listed below:
1. The presence of an actual or potential health threat posed to group
members by the site. This criterion can be met by establishing a
demonstrable threat to members' health or a reasonable belief that
the site poses a substantial threat to their health. (30 points)
2. The applicant best represents groups and individuals affected by the
site. (20 points)
3. The identification of how the group plans to use the services of a
technical advisor throughout the Superfund response action. (20
points)
4. The demonstrated intention and ability of the applicant to inform
others in the community of the information provided by the techni-
cal advisor. (20 points)
5. The presence of an actual or potential economic threat or threat of an
impaired use or enjoyment of the environment to group members
that is caused by the site. This criterion can be met by establishing a
demonstrable economic or environmental threat to group members
or a reasonable belief tihat the site poses a substantial economic or
environmental threat. (10 points)
The "Project Narrative Statement" section of your application is where
you will demonstrate that your group meets these criteria. You need
only supply a paragraph to address each of the above criteria. If EPA re-
ceives competing applications for one site, it will rank each against all
other applications submitted for that TAG. EPA may contact you for
clarification or additional information.
EPA NOTIFICATION OF GRANT APPLICANTS
EPA will evaluate your application within 30 days of its receipt. Once it
has reviewed your completed application, EPA will send you a written
notice telling you whether any additional information or clarification is
needed. If your application has been approved, EPA's Award Official
will prepare, sign, and return to you a grant agreement, which your
group's project manager also must sign.
The grant agreement specifies TAG budget and project periods, the fed-
eral share of project costs, the matching funds that your group will con-
tribute, a description of the work to be accomplished, and any special
conditions of the project. Within three calendar weeks of receiving the
11
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grant agreement, you must either sign and return the agreement to
EPA or request that EPA extend the time for acceptanceotherwise,
the grant agreement may become null and void.
ACCEPTING A GRANT AGREEMENT
EPA will set aside federal funds for the amount stated in the grant
agreement as soon as the Award Official signs the grant agreement. You
may not incur any costs until you and the EPA Award Official have
signed the grant agreement, with the exception of the cost of incorporation.
1 ' ! ! i
By signing and accepting a grant agreement, you are promising to com-
ply with all terms and conditions of the grant agreement, including any
special conditions necessary to assure compliance with applicable EPA
state laws, regulations, and policies. You are responsible for efficiently
and effectively managing the project, completing the project according
to the schedule and within budget, and meeting all monitoring and re-
porting requirements.
The terms of the grant, as well as the
workplan and budget contained in
your approved application, are legally
binding. They may be changed only
through a formal grant amendment.
Other items may be changed in consul-
tation with EPA. Contact your Re-
gional TAG Coordinator if you have
any questions.
When you receive
your grant, note
carefully the:
gW^ffrTOWli^lETlliytf^
Dollar amount
awarded.
project period shown
on the first page.
Approved budget.
Non-federal percent-
age shown.
Special conditions
that may be included.
12
"'' .' !, ; I ' '''!,. ": ! ,
L, i i!J, ;,i,iif"i|' !'!! I. , ! ;,' . ! id' -.,;
-------
^^
Q Submit a Letter of Intent (LOT).
Q Read this booklet carefully.
Q If your group knows of other groups planning to apply for a
TAG at the site you are concerned about, try to form a
coalition to submit one joint TAG application.
Q If there is such a group, but you are unable to form a coalition,
notify EPA that you will be submitting a separate application.
Q Contact the appropriate state office to determine the intergov-
ernmental review requirements for your state. DO THIS
EARLY.
Q Complete the grant application package:
The grant application fprm, "Application for Federal
Assistance" (EPA Standard Forms 424,424A, 424B, and
the Project Narrative Statement).
Certification Regarding Debarment, Suspension, and
Other Responsibility Matters," (EPA Form 5700-49), if
your group seeks a grant of $25,000 or more.
If you're applying for a waiver of the matching funds
requirement, include the relevant information.
Q Submit your application for intergovernmental review, if
necessary.
Q Send the original version and two copies of your completed
and signed grant application to your EPA Regional Office
while the intergovernmental review process is being
completed.
Q Upon notification that your group's application is approvable
and prior to signing the grant agreement, file the appropriate
documents for incorporation with the proper state agency, if
you haven't done this already. Submit evidence that you have
done so to EPA.
Q Upon receipt of the grant agreement, sign and return it to EPA
within three calendar weeks.
13
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NOTE: Underlined terms are defined elsewhere in the glossary. .
Amendment:
See "Formal Amendment."
Applicant:
Any group of individuals that files an application for a Technical Assistance
Grant (TAG).
Application:
A completed formal written request for a TAG that is submitted to EPA on EPA
Standard Form 424, or to a state on its appropriate form.
Award:
The Technical Assistance Grant agreement signed by both EPA and the recipient.
Award Official:
The EPA official authorized to sign grant agreements.
Budget:
A financial plan for the spending of all federal and matching funds (including irv
kind contributions) for a Technical Assistance Grant project, proposed by the ap-
plicant and approved by the Award Official.
Budget Period:
The length of time specified in a grant agreement during which the recipient
may spend or obligate federal funds. The budget period may not exceed three
years. A TAG project period may be comprised of several budget periods.
Code of Federal Regulations (CFR):
An annually revised modification of the rules published in the Federal Register by
the executive departments and agencies of the federal government. The CFR is
divided into 50 titles which represent broad areas subject to federal regulation.
Actions by EPA are governed by Title 40 of the CFR.
Comprehensive Environmental Response, Compensation, and Liability Act of
1980 (CERCLA), as amended:
A federal law passed in 1980 and modified by the Superfund Amendments and
Reauthorization Act of 1986 (SARA). Commonly know as Superfund. CERCLA
is intended to protect human health and the environment.
Continuation Application:
Application for the extension of a grant agreement for an additional budget pe-
riod, beyond the date to which EPA agreed to fund a specific project. A continu-
ation would be used at the end of each budget period; thus, several may be nec-
essary for one project.
15
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"' il ."in ''
Contract
A written agreement between the TAG recipient and another party (a contractor
other than a public agency) for services or supplies necessary to complete the
TAG project.
Contractor:
Any party (i.e., technical advisor) to whom a recipient awards a contract
Debarmenfc
An action taken by the Director, Grants Administration Division, U.S. EPA un-
der federal regulations (40 CFR part 32) to deny an individual, organization, or
unit of government the opportunity to participate in EPA grant agreements or to
receive contracts.
EPA: _
The U.S. Environmental Protection Agency. Where a state administers the Tech-
nical Assistance Grant Program, the term "EPA" may mean a state agency.
EPA Regional Office:
An EPA office located in one of the ten EPA Regions.
Expenditure:
The payment of a financial obligation, which involves issuing checks or spend-
ing cash. An example of an expenditure that might be made under a TAG
would be paying a technical advisor for the time he/she spent reviewing a site
feasibility study.
Formal Amendment:
A written modification of a grant agreement signed by both the award Qffe
cial and the authorized representative of the recipient.
Grant Agreement:
A legal document that transfers money to a recipient to accomplish the purpose
of the Technical Assistance Grant project. It specifies budget and project periods,
the federal and matching shares of eligible project costs, a description of the
work to be accomplished, and any special conditions.
I |i ,! ' r ', ' ,''
* , I i ,n
Grant Administrator:
A person hired by the recipient group to handle some or all of the tasks related
to the administration of the TAG.
Incorporation:
To form a legal corporation. Incorporation protects the individual members of
your group from potentially serious personal liability problems that could result
if the grant is awarded to a group or organization that is not incorporated.
In-Kind Contribution:
The value of a non-cash contribution used to meet all or part of a recipient's
matching funds requirement in accordance with 40 CPR 30.307(b). An in-kind
contribution may consist of charges for equipment or the value of goods and ser-
vices necessary to and directly benefiting the EPA-funded project and approved
in your grant budget.
16
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Intergovernmental Review of Application:
the applicant's state is provided the opportunity to review the grant application.
This process is designed to inform appropriate state agencies about all applica-
tions for federal assistance funds that have been received from their jurisdiction.
Letter of Intent (LOI):
Letter vised to advise EPA of a group's interest in applying for a TAG and to trig-
ger EPA's formal process for notifying other interested parties that an applica-
tion soon will be filed.
Matching Funds:
The portion of allowable project costs that a recipient must contribute toward
completing the TAG project using in-kind contributions and/or cash contribu-
tions in non-federal funds (or federal funds, if expressly authorized by law).
National Priorities List (NPL):
EPA's list of the most serious hazardous waste sites identified for possible long-
term remedial response. EPA is required to update the NPL and publish it in the
Federal Register at least once a year.
Nonprofit Organization:
Any corporation, trust, association, cooperative, or other organization which: (1)
is operated primarily for scientific, educational, service, charitable, or similar
purposes in the public interest; (2) is not organized for profit; and (3) uses its net
proceeds to maintain, improve, and/or expand its operations.
Operable Unit:
A response action taken as one part of an overall site response. A number of op-
erable units can be used in the course of a site response.
Potentially Responsible Party (PRP):
Any individuals) or company(ies) (such as owners, operators, transporters, or
generators) potentially responsible under sections 106 or 107 of CERCLA for the
contamination problems at a Superfund site.
Project Manager:
The person legally authorized to obligate the organization to the terms and con-
ditions of EPA's regulations and the grant agreement. This person or their des-
ignee will serve as the principal contact with EPA.
Project Period:
The period of time specified in the grant agreement for completion of all project
work. It may be composed of more than one budget period.
Recipient:
Any group of individuals that has been awarded a TAG.
Record of Decision (ROD):
The document identifying and explaining the selected remediation for the con-
tamination problem at a Superfund site.
17
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Regional Technical Assistance Grant (TAG) Coordinator:
The official designated in the grant agreement as EPA's TAG Program contact
with the recipient. TAG Project Officers are responsible for monitoring the
project.
Removal:
An immediate action taken over the short-term to address a release or threatened
release of hazardous substances.
'"' 'l: 1 "''!' ' ! ' ' " ! :: "
Response Action:
All activities undertaken to address the problems created by hazardous sub-
stances at a site. It begins when EPA, other federal agencies, states, or P_RP§ set
aside funds for these activities. The document that formally guarantees funding
during the coming fiscal year is EPA's annual Superfund Comprehensive Accom-
plishments Plan (SCAP).
Split Sampling:
Sending a sample (soil, water, etc.) to multiple laboratories for concurrent, inde-
pendent analysis.
Superfund:
The common name used for the Comprehensive Environmental Response, Com-
pensation, and Liability Act of 1980 (CERCLA).. Superfund was established by
CERCLA to help pay for the cleanup of hazardous waste sites and to take legal
action to force those responsible for the sites to clean them up.
Technical Advisor:
A person hired by a Technical Assistance Grant recipient to help affected groups
and individuals interpret site-related documents regarding the nature of the haz-
ard at the Superfund site for which the grant has been received.
' ' * "".. ,"'' ! ', " " ! !'.
Technical Assistance Grant Project:
The activities or tasks identified in the grant agreement that describe the technical
assistance offered to the recipient.
it U.S. Government Printing Office: 1994 - 300-642 (12630)
18
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EPA Project Control Number
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS. GRANTS. LOANS. AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been 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 any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any Federal
grant, the making of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any Federal contract, grant,
loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, 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 of
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification ,is a prerequisite for making
or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
Typed Name and Title of Authorized Representative
Signature of Authorized Representative Date
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BLANK APPLICATION DOCUMENTS
These are the blank copies of each document you will need to fill out to complete your TAG application.
While these are standard federal grant forms, EPA has developed instruction specifically for TAG applicants
to use in completing these forms. Whenever questions on these forms call for standard answers by TAG
applicants, EPA has supplied the correct response to simplify the application process for you.
Documents you will find in this section include:
Application for Federal Assistance.
General Information, Signature, and Certification (SF 424)
Budget Information (SF 424A)
Assurances (SF 424B)
Project Narrative Statement
Certification Regarding Debarment, Suspension, and Other Responsibility Matters
(EPA Form 5700-49).
Drug Free Workplace Certification.
Certification Regarding Lobbying.
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APPLICATION FOR
FEDERAL ASSISTANCE
OMB Approval No. 0348-0043
12. DATE SUBMITTED
Applicant Identifier
, TYPE OF SUBMISSION:
Application
C Construction
ffi Non-Construction
Preapplication
3 Construction
G Non-Construction
3. DATE RECEIVED BY STATE
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY
Federal Identifier
5. APPLICANT INFORMATION
Legal Name:
Organizational Unit:
Address (give aty. county, stale, and zip code):
Name and telephone number of person to be contacted on matters involving this
application (give area code)
7. TYPE OF APPLICANT: (enter appropriate letter in box)
6. EMPLOYER IDENTIFICATION NUMBER (BIN):
8. TYPE OF APPLICATION:
~ New
! Continuation
^2 Revision
If Revision, enter appropriate letter(s) in box(es)
A. State
B, County
C. Municipal
D. Township
E. Interstate
F. Intermunicipal
G. Special District
H. Independent School Dist.
I. State Controlled Institution of Higher Learning
J. Private University
K. Indian Tribe
L. Individual
M. Profit Organization _. . .
N. Other (Specify) Nonprofit Citizen
Organization
A. Increase Award B. Decrease Award C. Increase Duration
D. Decrease Duration Other (specify):
9. NAME OF FEDERAL AGENCY:
U.S. Environmental Protection Agency
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT:
TITLE Super fund Technical Assistance Gran-
12. AREAS AFFECTED BY PROJECT (Cities. Counties, Slates, etc.):
13. PROPOSED PROJECT
! 14. CONGRESSIONAL DISTRICTS OF:
Start Date
Ending Date ! a. Applicant
; b. Project
15. ESTIMATED FUNDING:
a. Federal
b. Applicant
c. State
d. Local
e. Other
f. Program Income
.00
.00
.00
.00
.00
.00
g. TOTAL
.00
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER
12372 PROCESS?
a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR
REVIEW ON:
DATE
b. NO. D PROGRAM IS NOT COVERED BY E.0.12372
D OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
d Yes If "Yes," attach an explanation. D No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPUCAT1ON ARE TRUE AND CORRECT, THE DOCUMENT HAS
BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE
ASSISTANCE IS AWARDED.
a. Type Name of Authorized Representative
b. Title
c. Telephone Number
d. Signature of Authorized Representative
e. Date Signed
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 424 (REV. 4-92)
Prescribed by OMB Circular A-102
-------
-------
OMB Approval No. 0348-004
-------
: : : : i - ;; s - -> M *:._._--;-
SECTPMC»HaN-FEDERALRESaURCES : ' ; , :n
(a) Grant Program
p
Technical Assistance at:
9.
10.
11.
12. TOTAL (sum of lines 8 - 11 )
(b) Applicant
5
*
(c) State
$
$
(d) Other Sources
$
S
(6) IUIALS
5
$
-, - ,' ' "i - , -.:,,_;; ^ectiOND^ftCA^f-bCASHNeEDS j * ~ * ', X\'', ''.'^ ' 1 ^
13. Federal
14. NonFederal
15. TOTAL (sum of lines 13 and 14)
Total for 1st Year
$
$
1st Quarter
$ " ~~ ~"
$
2nd Quarter
$
$
3rd Quarter
$
$
4th Quarter
$
$
, ,; SECTION E/BU^ ;
(a) Grant Program
16- Technical Assistance Grant at:
17.
18.
19.
20. TOTAL (sum of lines 16-19)
FUTURE FUNDING PERIODS (Years)
(b) First (c) Second
$
$
$
$
(d) Third
$
$
(e) Fourth
$
$
SECTION F-#TBEB BUDGET INFORMATION ' , ;
21. Direct Charges:
22. Indirect Charges:
23. Remarks:
Authorized for Local Reproduction
Standard Form 424A (Rev. 4-92) Page 2
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OMB Approval No. 0348-0040
ASSURANCES NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management
and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program, If you have questions, please contact
the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to
additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of United States, and if appropriate, the State, through
any authorized representative, access to and the right to
examine all records, books, papers, or documents related
to the award; and will establish a proper accounting
system in accordance with generally accepted
accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and^ complete the work within the
applicable time frame after receipt of approval of the
awarding agency.
5. Will comply with the Intergovernmental Personnel Act
of 1970 (42 U. S. C. §4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the nineteen statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C. F. R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U. S. C. §1681-
1683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the Rehabilitation
7.
Act of 1973, as amended (29 U. S. C. §794), which
prohibits discrimination on the basis of handicaps; (d) the
Age Discrimination Act of 1975, as amended (42 U. S. C.
§6101-6107), which prohibits discrimination on the
basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P. L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism
Prevention, Treatment and Rehabilitation Act of 1970
(P.L. 91-616), as amended, relating to nondiscrimination
on the basis of alcohol abuse or alcoholism; (g) §§523 and
527 of the Public Health Service Act of 1912 (42 U.S.C.
290 dd-3 and 290 ee-3), as amended, relating to
confidentiality of alcohol and drug abuse patient records;
(h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C.
§3601 et seq.), as amended, relating to nondiscrimination
in the sale, rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for fair
and equitable treatment of persons displaced or whose
property is acquired as a result of Federal or federally
assisted programs. These requirements apply to all
interests in real property acquired for project purposes
regardless of Federal participation in purchases.
Will comply, as applicable, with provisions of the Hatch
Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit
the political activities of employees whose principal
employment activities are funded in whole or in part with
Federal funds.
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 424B (Rev. 4/92)
Prescribed by OMB Circular A-102
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9. Will comply, as applicable, with the provisions of the
Davis-Bacon Act (40 U.S.C. §§276a to 276a - 7), the
Copeland Act (40 U.S.C. §§276c and 18 U. S. C.
§§874), and the Contract Work Hours 'and Safety
Standards Act (40 U.S.C. §§327-333), regarding labor
standards for federally assisted construction
subagreements.
10. Will comply, if applicable, with flood insurance
purchase requirements of Section I02(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234) which
requires recipients in a special flood hazard area to
participate in the program and to purchase flood
insurance if the total cost of insurable construction and
acquisition is S 10.000 or more.
11. Will comply with environmental standards which
may be prescribed pursuant to the following: (a)
institution of environmental quality control
measures under the National Environmental Policy
Act of 1969 (P.L. 91-190) and Executive Order (EO)
11514; (b) nou'fication of violating facilities pursuant
to EO 11738; (c) protection of wetlands pursuant to EO
11990: (d) evaluation of flood hazards in floodplains in
accordance with EO 11988; (e) assurance of project
consistency with the approved State management
program developed under the Coastal Zone
Management Act of 1972 (16 U.S.C. §§1451 et seq.);
(f) conformity of Federal actions to State (Clear Air)
Implementation Plans under Section I76(c) of the
Clear Air Act of 1955, as amended (42 U.S.C. §§ 7401
et seq.); (g) protection of underground sources of
drinking water under the Safe Drinking Water Act of
1974, as amended, (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act
of-1973, as amended, (P.L. 93^-205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. 470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of 1974
(16U.S.C.469a-l etseq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.)
pertaining to the care, handling, and treatment of warm
blooded animals held for research, teaching, or other
activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§ 4801 et seq.) which
prohibits the use of lead based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act of 1984 or OMB Circular No. A-133, Audits of
Institutions of Higher Learning and other Non-profit
Institutions.
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations and policies
governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
APPLICANT ORGANIZATION
DATE SUBMITTED
Standard Form 4241 (Rw. 4/S2) b*«K
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Project Narrative Statement
PROJECT NARRATIVE STATEMENT
Section 1 (Group Qualifications)
A. Group Eligibility
1. Do any of the following categories apply to your group? (yes/no) If the
answer is yes, check the categories below that apply and provide a detailed
explanation.
Are any members of your group potentially responsible parties (PRPs)?
_Was your group established by a PRP?
_Was/is your group sustained by a PRP?
_Was your group established by, or is it presently sustained by, any of the
following:
_a corporation that is not incorporated for the specific purpose of repre-
senting affected individuals at the site?
_an academic institution?
_a political subdivision?
Does anyone in your group have financial involvement in a PRP (as other
than an employee or contractor)?
2. How many members are in your group? Is it made up of a coalition of
groups? (yes/no) If so, how many, and how did the groups come to-
gether? If not, how was your group formed?
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Project Narrative Statement
Section 1, cont.
B. Responsibility Requirements
1. Administrative and Management Capabilities: Please briefly describe the organi-
zational structure of your group in the space below. (Describe roles and responsibili-
ties of members, particularly members who will be responsible for financial manage-
ment of the grant and directing the activities of the contractor.)
2. Resources for Project Completion: What resources are available to your group to
help complete the TAG Project? (Include any plans that your group has for in-kind
contributions or for fund-raising and obtaining cash.)
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Project Narrative Statement
Section 1, cont.
3. Performance Record: Please describe your group's past performance with
satisfactorily completing projects and contract. (If your group has no past experi-
ence, EPA will evaluate the description, budget, and schedule you provide in
Section 2 of this application.)
4. Accounting and Auditing Procedures: What procedures does your group plan
to use for recordkeeping and financial accountability related to the grant? Please
identify the member of your group who will maintain your financial records.
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Project Narrative Statement
Section 1, cont.
5. Incorporation: Is your group incorporated specifically for the purpose of addressing
problems at this site? (yes/no) If not, what steps is your group taking to
incorporate for grant-related purposes?
6. Drug-Free Workplace Policy: Does your group promise not to engage in illegal
drug-related activities while carrying out activities using TAG funds? (yes/no)
C. Group Issues and Objectives
1. Health Considerations: How many group members have experienced health
effects from contamination atthie-site?- Describe actual or potential health
threats the site poses to individual group members and the efforts members of your
group have undertaken to resolve or make known these health concerns.
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Project Narrative Statement
Section 1, cont.
2. Consolidation/Representation: Describe the number and diversity of affected
community organizations and individuals represented by your group, highlighting the
ways in which your group represents individuals affected by the site.
3. Tasks for Technical Advisors: Please describe how your group intends to use
your technical advisor to interpret technical Superfund information.
4. Information Sharing: How does your group intend to share information collected
with grant funds with the larger community?
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Project Narrative Statement
Section 1, cont.
5. Economic/Environmental Considerations: How many group members have
experienced economic/environmental impacts from contamination at the site?
Please describe the actual or potential economic harm or loss of environmen-
tal amenities the site has imposed on individual group members, and efforts group
members have undertaken to resolve or make known these concerns.
Section 2 - Statement of Work for the Technical Advisor
A. Statement of Work: Please identify the technical advisor(s)' tasks for each phase of
the Superfund process. For each of these phases, please note what the technical
advisor will do, the estimated amount of time needed to complete each task, and
specific documents, reports, or other tangible work products you expect the technical
advisor to produce.
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Project Narrative Statement
Section 2, cont.
B. Detailed Budget: Prepare a budget for the technical assistance project. Indicate
the tasks to be completed by the technical advisor, the estimated number of hours,
and the cost for each task (including travel costs). Use footnotes to explain as-
sumptions made in the budget (such as hourly rate of advisor or adjustments for
inflation). This budget should identify everything that you expect to purchase with
grant funds.
The budget should show the amount of the group's matching contribution sepa-
rately from federal funds. Note that the grant funds (usually 80 percent) plus group
contribution (usually 20 percent) must equal the total project costs; grant funds
cannot exceed 80 percent of project costs for any budget period. In your state-
ment, be sure that you differentiate cash expenditures from in-kind contributions.
Also, include explanations of the assumptions made in calculating the value of in-
kind contributions.
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N-/EPA
EPA Project CorAvot Numbe:
United States Environmental Protection Agency
Washington, DC 20460
Certification Regarding
Debarment, Suspension, and Other Responsibility Matters
The prospective participant certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) Have not within a three year period preceding this proposal been convicted of or had a civil judgement
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal,
State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification; and
(d) Have not within a three-year period preceding this application/proposal had one or more public
transactions (Federal, State, or local) terminated for cause or default.
I understand that a false statement on this certification may be grounds for rejection of this proposal or
termination of the award. In addition, under 18 USC Sec. 1001, a false statement may result in a fine of up
to $10,000 or imprisonment for up to 5 years, or both.
Typed Name & Title of Authorized Representative
Signature of Authorized Representative
Date
I | | am unable to certify to the above statements. My explanation is attached.
EPA Form 5700-49 (11-88)
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Ass/stance Identification Number:.
CERTIFICATION DRUG FREE WORKPLACE ACT OF 1988
The recipient certifies that it will provide a drug-free workplace by:
(a) publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the recipient's workplace and specifying the
actions that will be taken against employees for violation of such prohibition;
(b) establishing a drug-free awareness program to inform employees about:
(1) the dangers of drug abuse in the workplace;
(2) the recipient's policy of maintaining a drug-free workplace;
(3) any available drug counseling, rehabilitation, and employee assistance programs; and
(4) the penalties that may be imposed upon employees for drug abuse violations occurring in the
workplace;
(c) making it a requirement that each employee engaged in the performance of the project be given a copy
of the statement required by paragraph (a);
(d) notifying the employee in the statement required by paragraph (a) that, as a condition of employment
under the award, the employee will:
(1) abide by the terms of the statement; and
(2) notify the employer of any criminal drug statute conviction for a violation occurring in the work-.
place no later than five days after such convictions;
(e) notifying the Award Official within ten days after receiving notice under subparagraph (d) (2) from an
employee or otherwise receiving actual notice of such conviction;
(f) taking one of the following actions, with 30 days of receiving notice under subparagraph (d){2), with
respect to any employee who is so convicted:
(1) taking appropriate personnel action against such an employee, up to and including termination; or
(2) requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation
program approved for such purposes by a Federal, State, or local health, law enforcement, or
other appropriate agency;
(g) making a good faith effort to continue to maintain a drug-free workplace through implementation of
paragraphs (a), (b), (c), (d), (e), and (f).
The recipient shall insert in the space provided below the site(s) for performance of
work done in connection with the specific award
Place of performance (street address, city, county, state, zip code)
Typed Name and Title of Authorized Representative
Signature of Authorized Representative Date
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