x'/EPA
United States
Environmental Protection
Agency
Solid Waste and
Emergency Response
(5204G)
EPA 540-R-97-037
September 1998
www.epa.gov/superfund
Community Advisory Group
Toolkit
For the Community
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Community Advisory Group
Toolkit
Community Involvement and Outreach Center
Office of Emergency and Remedial Response
U.S. Environmental Protection Agency
Washington, B.C.
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Introduction
Part 1: How To
i
Meet the Community Advisory Group
Tips for Involving Hard-To-Reach Segments
of the Community 3
Let's Get Started 5
Writing a Mission Statement 9
Developing Operating Procedures 11
Incorporating Your Community Advisory Group 13
Securing Tax-Exempt Status 17
Community Advisory Groups and
Technical Assistance Programs 21
Finding Funding for Community Advisory Groups 27
Part 2: Community Tools
How To Write a Proposal Al
Community Advisory Group: Our Voice in EPA
Decisions [Presentation] Bl
Community Advisory Group: Our Voice in EPA
Decisions [Script Notes] Cl
Operating Procedures Dl
IRS Form (SS-4) for Applying for Employer ID El
IRS Instructions and Forms (1023, 872-C, and 8718)
for Applying for Recognition of Tax-Exempt Status .... Fl
Superfund Technical Assistance Grant (TAG)
Handbook: Applying for Your Grant Gl
Technical Outreach Services for
Communities............................................. HI
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Ihe U.S. Environmental Protection Agency (EPA) wants the public to participate
in decision-making at Superfund and other sites with environmental problems. Early
and direct public involvement results in better decisions on how to deal with envi-
ronmental problems at these sites.
Forming a Community Advisory Group is one of the most effective ways a commu-
nity can participate in environmental decisions. A Community Advisory Group is a
committee, task force, or board made up of residents of a community with Superfund
or other environmental problems. The Community Advisory Group enhances public
participation in the cleanup process and other environmental decision-making by
providing a public forum where community representatives can discuss their diverse
interests, needs, and concerns.
The Community
ftdvisory Group
Toolkit
This Toolkit is designed to provide a
variety of information to help you set up
your Community Advisory Group. The
Toolkit has two parts:
Part 1 is a collection of "how to"
information. It includes step-by-step
information on organizing your
Community Advisory Group and
suggestions about some of the major
things to consider as you do so.
Part 2 contains "tools"such as
outlines, forms, publications, and
other materialsfor use in estab
lishing and maintaining your Com
munity Advisory Group.
How To Use the Toolkit
The "how to" information in Part 1 and
the tools in Part 2 are cross-referenced
to make the Toolkit easy to use. Each
tool in Part 2 is numbered. Each tool is
mentioned, where appropriate, in the
"how to" information, and the tool's
number appears in the bar at the bottom
of each page in that section to guide
readers to its location in Part 2 of the
Toolkit.
Deciding which tools to use and in what
order will depend on your Community
Advisory Group's stage of development.
Communities that are just beginning to
consider forming a Community Advisory
Group may choose to use all the materi-
als in the order they appear in the
Toolkit. Some Community Advisory
Groups may find the materials focusing
on how to incorporate, apply for status
as a nonprofit organization, or find and
apply for additional funding to be more
useful immediately. The materials in the
Toolkit may be used singly or in what-
ever combination makes most sense for
your Community Advisory Group.
Wherever possible, additional sources of
useful information, such as organiza-
tions, publications, and World Wide Web
sites about the various topics are listed.
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How To
Meet the Community Advisory Group 1
Tips for Involving Hard-To-Reach Segments of
the Community 3
Let's Get Started 5
Writing a Mission Statement 9
Developing Operating Procedures 11
Incorporating Your Community Advisory Group 13
Securing Tax-Exempt Status 17
Community Advisory Groups and
Technical Assistance Programs 21
Finding Funding for Community Advisory Groups 27
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The Community
Advisory Group
is a way for people
in the community
to actively
participate in
the decision-
making process
at sites with
Superfund
and other
environmental
concerns. Citizens
who are part of
Community
Advisory Groups
can learn more
about their site, get
up-to-date
information about
cleanup status, ask
questions,
and discuss
community
concerns with the
U.S. Environmen-
tal Protection
Agency (EPA),
state and tribal
agencies, and other
parties involved
in cleanup or
addressing other
environmental
concerns.
Meet the
Community
flc/v/soru Group
September 1998
Full community participation and
representation of all viewpoints are
essential to the success of the
Community Advisory Group. How-
ever, it is not practical for everyone
in the community to be a member of
the Community Advisory Group. The
membership usually is made up of
people who represent the various
interests in the community. These
may include residents or owners of
residential property near the site,
those who may be affected directly
by site releases, those who may be
affected by releases from the site,
even if they do not live nearby or
own property near the site, and
environmental and other experts
from local universities.
In addition to the community itself, a
number of other groups are involved
in making decisions about site
cleanup and other environmental
issues. These include the U.S. EPA
and other federal agencies; state,
tribal, and local government organi-
zations; and facility owners and
others who are potentially respon-
sible for the contamination at the
site. These groups work closely with
the Community Advisory Group. In
some cases, communities may
choose to include representatives of
local governments and potentially
responsible parties as Community
Advisory Group members.
What Community
Advisory Group
Members Do
Membership on a Community Advi-
sory Group involves making a major
-1-
commitment. Members must be
prepared to devote considerable time
and effort in order for the Community
Advisory Group to be effective. While
many citizens may be interested, only a
few may be able to make the neces-
sary commitment.
Members are responsible for learning
about site issues. They attend and
participate in all Community Advisory
Group meetings and share information
regularly with their fellow community
members. Community Advisory Group
members also review information
concerning site cleanup plans and
provide data and information to EPA on
the community's issues and concerns
about the site. A Community Advisory
Group member from Texas summed it
up well when she observed that anyone
who serves as a member of a Commu-
nity Advisory Group must be willing "to
work a lot of nights, talking things over
and figuring out what to do."
What People in the
Community Can Do
To Help
Even if every citizen cannot be a
member of the Community Advisory
Group, every citizen has an impor-
tant role in the site remediation
process and can support the Commu-
nity Advisory Group and its activities.
One of the best ways to get involved in
and support the Community Advisory
Group is to attend its meetings and
participate actively in discussions.
People in the community can contrib-
ute to the work of the Community
Advisory Group in other ways as well.
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Parents and Long-time Residents
Parents and long-time residents can help
the Community Advisory Group identify
issues concerning children and the elderly,
who are among the most vulnerable
groups in a community. Long-time
residents also can be excellent sources of
historical information about the site, the
surrounding community, and its residents.
Community Organizations
Community organizations, such as
homeowner and neighborhood associa-
tions, tenant organizations, and senior
citizens groups, can provide important
support to Community Advisory Groups.
Local Parent-Teacher Associations
(PTAs) and school boards, for example,
can help the Community Advisory Group
work with the community's schools to
inform and educate the residents about
the site and about the cleanup process.
Churches
Churches provide excellent ties to
residents and may be particularly helpful
in reaching some economically disadvan-
taged residents. Many churches contrib-
ute financial support to worthwhile
community projects and nonprofit organi-
zations and may provide space for
Community Advisory Groups to meet.
Environmental Groups
Local environmental groups can
contribute their knowledge of environ-
mental issues and their experience to
the Community Advisory Group.
Medical and Science Professionals
Local medical and public health profes-
sionals can provide technical expertise
on health-related issues; they may be
the first to observe the potential for
health effects in their patients. Scientists
and engineers also can offer their
expertise to review technical information.
Business, Industry, and Banks
Small businesses and local merchant or
business associations can help get
information out to the community. These
groups also may be willing to donate low-
cost printing services, office supplies,
meeting space, or even refreshments for
Community Advisory Group meetings and
other activities.
Major industries, large employers and
large businesses can contribute goods and
services to the Community Advisory
Group. In fact, they often are eager to be
"good corporate citizens" by supporting
worthwhile community projects. Large
companies and industrial plants may have
technical experts who will donate exper-
tise or services on a pro bono basis.
Many local public utility companies have
active community relations programs
with significant budgets for supporting
community projects. Some utility compa-
nies encourage their employees, including
engineers and other technical experts, to
volunteer their time to support commu-
nity activities such as Community
Advisory Groups.
Banks may be willing to underwrite
some Community Advisory Group
operations and to support activities that,
in effect, protect their investments in the
community.
What Others Involved
in Environmental
Cleanup Can Do
The other groups involved in address-
ing environmental issues can support
the Community Advisory Group in
several ways.
State, Tribal, and Local
Governments
In some cases, the city or county
government may provide admin-
istrative support for the Commu-
nity Advisory Group. Some local
governments also may provide
funding for activities or events
sponsored by the Community
Advisory Group.
Representatives of state and
tribal agencies often work closely
-2-
with federal and local officials and may
attend Community Advisory Group
meetings on a regular basis. Some
states also may have programs that
would provide funds for Community
Advisory Group functions, such as
hiring technical advisors.
Local elected officials can bring
Community Advisory Group issues
before their councils, boards, and
commissions. They often know of
other programs and funding sources
that Community Advisory Groups can
contact for additional resources and
expertise.
U.S. EPA
As the federal regulatory agency
responsible for hazardous waste
remediation, U.S. EPA can work
closely with Community Advisory
Groups. EPA Regional Office staff can
attend Community Advisory Group
meetings to provide information about
cleanup plans and activities and to
discuss community questions and
concerns. EPA also provides informa-
tion and other tools to assist communi-
ties in establishing Community Advi-
sory Groups and actively participating
in the decision-making process.
September 1998
-------
Participation by all
segments in the
community is
important to the
success of a
Community Advisory
Group. Sometimes,
communities may need
to take special steps to
ensure that all citizens
can participate. This
is especially true in
communities with
low-income and
minority populations.
Involving citizens
from these groups not
only helps promote
full community
involvement, but also
can give the
Community Advisory
Group more power to
raise environmental
justice issues with
potentially
responsible parties.
fijps for/nvo/vi/ig
ffard-To-fteach
Segments of the
Com/mm/ty
September 1998
People in low-income and minority
groups often do not feel fully accepted
as members of the community as a
whole. They may feel the government,
the media, and civic organizations do
not care about them even if the rest of
the community sees it differently.
These segments of the community
may be reluctant to join in civic
activities, including Community Advi-
sory Group activities, even though they
have been affected by environmental
hazards more than others.
To encourage these citizens to work with
or participate actively in the Community
Advisory Group, carefully consider how
to reach and communicate effectively
with each individual group.
Encouraging
Participation as
Members of the
Community Advisory
Group
Listed below are some ideas to help
your community seek out hard-to-
reach groups and encourage them to
participate in the Community Advisory
Group:
Learn more about the low-
income and minority residents
in your community. Don't
assume anything. Start by asking
others in the community for help.
Ask where low-income families
or minority residents go for
information, what people or
organizations they trust and
listen to. Then, ask these people
-3-
for advice. Listen to what they
say and be willing to act on their
recommendations.
Start early and build partner-
ships with community activists
and organizations. Ask for a
meeting to discuss the hazards
faced by their community.
Explain how the Community
Advisory Group will work and
how important their participation
is to the residents they represent
and to the overall environmental
goals of the Community
Advisory Group.
Consider holding a special
meeting with low-income,
minority, and other hard-to-
reach groups. Be willing to take
important information to the
people who need it. This is
particularly helpful at the begin-
ning of the Community Advisory
Group process to explain the
problems the Community
Advisory Group will be working
to solve and to encourage these
stakeholders to participate.
Consider co-sponsoring a
meeting with a trusted commu-
nity group that supports the work
of the Community Advisory
Group. Schedule the meeting at a
time convenient for most mem-
bers of the community to attend.
Avoid schedule conflicts with
other community or cultural
events. ^"Presentation materi-
als that may be useful in
describing the Community
Advisory Group during these
See Tools B and C
-------
meetings is included in Part
2 of the Toolkit for your
convenience.
Make a long-term commitment.
Don't expect instant acceptance.
Build a relationship with the
individuals and groups you
contact and plan to continue
working with them for a while.
Be patient and respect each
organization's decision-making
process. Understand you will
have to build credibility first, and
that can take time.
Communicating
Effectively about the
Community Advisory
Group's Work
Everyone in the community cannot be
a member of the Community Advisory
Group and may not be able to attend all
the meetings. But all citizens, especially
low-income and minority residents,
have a stake in solving the
community's environmental problems.
And every citizen's support is needed
for the Community Advisory Group to
do its job effectively. As a result,
keeping all residents informed about
the work of the Community Advisory
Group is very important.
Listed below are some tips for making
sure information from the Community
Advisory Group gets to low-income,
minority, and other hard-to-reach
residents in your community.
Set up a Community Advisory
Group Outreach Committee.
Have the Committee look for the
best ways to communicate with
the community as a whole. This
demonstrates the Group's
commitment to working with all
parts of the community.
Promote community
empowerment. Stress that each
person has a voice, and that
every person can make a differ
ence by working together to
solve community problems.
Remember the "messenger"
can be as important as the
message. People are more likely
to listen to people and groups
they already know and trust. A
word from the minister on
Sunday can be worth more than
a story on the TV news. A flyer
received from a trusted friend
has instant credibility; the same
information sent through the mail
or received from a stranger
might not.
Use the networks the commu-
nity already trusts. Churches
can be very effective in reaching
various groups in the community.
Community action agencies in
most counties are experts at
outreach to low-income families.
Community health clinics,
English-As-A-Second-Language
programs, Boys and Girls Clubs,
senior centers, and Head Start
programs are excellent ways to
reach low-income, minority, and
other hard-to-reach stakeholders
in many communities.
Be culturally sensitive in
preparing information to be
distributed. Avoid stereotypes.
Use language that people
can understand, and don't
talk down to people. If you
prepare material that
includes illustrations or
photos, make sure they
include people of different
ethnic and racial back
grounds, in different age
groups, and with disabilities,
as appropriate.
Distribute information in
several ways. Do not rely
on a single organization,
newspaper, radio station, or
group for getting important
information out to community
residents. Use them all. This
helps make sure everyone
has a chance to get it.
Enlist help from commu-
nity organizations for
translations. If there is a
significant foreign-language
group in your area, there prob-
ably is at least one community-
based organization that works on
community issues affecting these
residents. Contact the group and
ask someone to provide input for,
review, and help translate your
materials.
See Tools B and C
-4-
September 1998
-------
A Community
Advisory Group is
a committee, task
force, or board
comprised of
residents of a
community with
Superfund or other
environmental
problems. This
Community
Advisory Group
enhances public
participation in the
cleanup process
and other
environmental
decision-making
by providing a
public forum,
where
representatives of
diverse community
interests can
discuss their needs
and concerns. This
section provides a
checklist of initial
steps that will help
you form a
Community
Advisory Group.
The sections that
follow provide
more detail on
several of the steps
outlined here.
September 1998
Forming a Community
Advisory Group
Community Advisory Groups may be
formed at any point in the environmen-
tal cleanup process. However, they are
most effective when formed early,
allowing the community more time to
participate in and have an impact on site
activities and decisions. While EPA can
provide ideas and assistance, it is up to
community residents to decide if and
how they want to form a Community
Advisory Group.
Generally, a core group of community
residents with a strong interest in
environmental issues takes the lead.
Some communities build their Commu-
nity Advisory Group from an existing
framework, while others start their
groups from scratch. In certain situa-
tions, local governments take steps to
form Community Advisory Groups.
The process often begins with a well-
publicized Community Advisory Group
Information Meeting. This meeting is
held to discuss the purpose of a Com-
munity Advisory Group, opportunities
for membership, and terms for participa-
tion. ^Presentation materials, which
-5-
you may want to use in describing
the Community Advisory Group at
meetings with others in the commu-
nity, are included in Part 2 of this
Toolkit for your convenience.
Choosing a Name
Decide whatyou will call your group. A
Community Advisory Group may be
called a committee, a task force, a board,
or an action group. You may choose to
include the words "Community Advisory
Group" in your name, but it is not required.
For example, the Community Advisory
Group at the Oronogo-Duenweg Mining
Belt Site in Jasper County, MO, calls itself
the "Jasper County EPA Superfund
Citizens Task Force." The name you
choose shouldreflectyour community's
vision for the group.
Writing a Mission
Statement
One of the first steps in forming a
Community Advisory Group is writing
a mission statement. A mission state-
ment is a short, to-the-point description
of the overall goals and purposes of
an organization.
See Tools B and C
-------
A written mission statement can be
distributed and discussed easily. It helps
keep the community informed and
educated about the Community Advisory
Group and provides a way to get com-
munity feedback at any point in the
process. Be willing to revise the mission
statement as issues and community
concerns change.
Determining Operating
Procedures
Establishing a basic structure for how the
Community Advisory Group will do its
work is another important first step.
Making these structure decisions early
allows members to focus on other issues.
Issues requiring immediate attention fall
into two categories, short-term and long-
term. Examples of two short-term issues
are choosing a name and determining
how many members should be on the
Community Advisory Group. Examples
of more long-term issues are determining
how often to hold meetings, how to
ensure diverse community participation,
and how to make necessary decisions.
Developing Effective
Communications
It is important to decide how Community
Advisory Group members will communi-
cate with each other. Decide how
members will be reminded of upcoming
meetings and how far in advance notice
will be given. Will members receive an
agenda in advance? Will they receive
minutes, a record of what happened, after
the meeting? How will they communicate
with each other about issues that arise
between scheduled meetings?
It also is important to determine how the
Community Advisory Group will commu-
nicate with the community at-large. How
will meetings be announced and how will
information be shared with the general
public? You may want to set up an
Outreach Committee to look for the
best ways to keep the community at-
large informed.
It is a good idea for each Community
Advisory Group to appoint one member
to act as a spokesperson to the media.
The spokesperson would be responsible
for coordinating the release of informa-
tion aboutthe Community Advisory
Group and answering calls from reporters.
It also is helpful to determine the most
important organizations you need to work
with and select a liaison for each organi-
zation. These might include schools,
businesses, environmental groups, or
other concerned groups in the community.
Incorporating and
Securing Tax-Exempt
Status
There are a variety of organizational
structures for Community Advisory
Groups. Before deciding which structure
to use, consider the following
questions: Willyour Community
Advisory Group have a board of
directors? Is it necessary to
develop a charter and written
bylaws? How will the organization
be funded? What actions must be
taken to ensure the organization
can receive and disperse funds?
Your Community Advisory Group
could exist for a long time, in
some case several years. As a
result, you need to consider
whether to incorporate or secure tax-
exempt status. It may be necessary to do
both in order to qualify for certain types
of governmentfunding or to receive
contributions or donations from some
sources.
Working with U.S. EPfi
In order to work effectively with EPA,
it important to understand how your
concerns and the information you
provide about the community's inter-
ests will be transmitted within the
Agency. It's a good idea to meet with
the Community Involvement Coordina-
tor from your EPA Regional Office to
discuss the flow of information be-
tween the Community Advisory Group
and the EPA Regional Office staff
who will be working with you. In
general, the EPA Community Involve-
ment Coordinator will be your primary
point of contact. He or she will answer
questions and provide other assistance
directly as well as see that your
concerns and other issues are transmit-
ted to other Regional Office staff who
can help. For example, if your site is a
Superfund site, the Community In-
volvement Coordinator would pass
See Tools B and C
September 1998
-------
information on to the EPA Remedial
Program Manager.
Additional Resources
The National Center for Nonprofit Boards
(NCNB) is a national nonprofit organiza-
tion dedicated to increasing the effective-
ness of nonprofit organizations by strength-
ening their boards of directors. Visit
NCNB's World Wide Web site at
www.ncnb.org or call 800-883-6262.
The nine-part Nonprofit Management
Series is available from Independent
Sector Publications. Some of the individual
publications in the series that may be of
interest to Community Advisory Groups
are: The Role of the Board and Board
Members (#1); Finding, Developing,
and Rewarding Good Board Members
(#2); Operating Effective Committees
(#3); Conducting Good Meetings (#4);
Fundraising (#7); and Budgeting and
Financial Accountability (#8). Cost:
$5.00 each for individual publications,
$35.OOfor the nine-volume set, plus
postage and handling. Call Independent
Sector Publications at 301-490-3229 for
more information or write to them at
Independent Sector Publications, P.O. Box
451, Annapolis Junction, Maryland 20701.
September 1998
-1-
See Tools B and C
-------
-8-
-------
A mission
statement is
a short,
to-the-point
description of
the overall
goals and
purposes of an
organization.
The mission
statement brings
a clear focus to
an organization,
allowing
members to
see how their
actions support
the goals and
purposes of their
organization.
U/riti/ig a
Mss/oa
State/neat
September 1998
Developing the
Mission Statement
There are four primary questions Commu-
nity Advisory Groups must answer in
writing a mission statement:
What function does the Community
Advisory Group perform?
For whom does the Community
Advisory Group perform this function?
How does the Community Advisory
Group go about filling this function?
Why does this Community Advisory
Group exist?
What
Choose the areas that are particularly
important to the Community Advisory
Groupthe ones you are willing to stand
behind until a solution is found. If a particu-
lar type of remedial action is not the best
choice for your community, then one
function of the Community Advisory Group
might be to bring other remedial options to
the discussion table.
Who
Identify who the Community Advisory
Group represents and the primary
concerns of the community. This might
-9-
include identifying the ages, incomes,
and ethnic groups in the community.
How
List how the Community Advisory
Group can achieve its goals. Is the
Community Advisory Group's function
to educate the public? Solicit opinions?
Monitor the hazardous waste cleanup
process? Others?
Why
Identify why the Community Advisory
Group will perform the functions it has
selected. List these driving forces and
rank them to help you allocate resources
and determine the direction your
Community Advisory Group will take.
Writing the
Mission Statement
You are now ready to put the mission
statement on paper. Write a statement
in one sentence or a short paragraph
that answers the what, who, how, and
why questions from above. Then list a
set of specific priorities for the Commu-
nity Advisory Group. Discuss the
statement and priorities, making adjust-
ments until all members feel comfort-
able and agree on the Community
Advisory Group's mission statement and
priorities.
-------
Examples of
Community Advisory Group Mission Statements
Following are examples of the mission statements developed by four Community Advisory Groups around the country.
They may be helpful references as you develop the mission statement for your Community Advisory Group.
EPA Community Advisory Group, Brio Refining,
Inc., Superfund Site (Harris County, TX):
To provide community input into the conduct of the Focused
Feasibility Study to ensure the remedy for the Brio
Superfund site is protective of human health and the envi-
ronment and is implemented in a timely manner.
Jasper County EPA Superfund Citizen's Task Force
(Jasper County, MO):
This Task Force is to: Develop a process to gather early,
direct, and meaningful comments; serve as a public forum
for community interests to present and discuss their needs
and concerns related to the Superfund decision-making
process with appropriate federal and state agencies;
Provide a public service to the rest of the community by
representing the community in discussions regarding the
site and by relaying information from the discussions back
to the rest of the community; Participate in the decision-
making process.
Southern Maryland Wood Treatment Plant Task
Force (Hollywood, MD):
To establish a single and complete source of all available
documentation and background material; serve as the
official point of contact with federal EPA and state DOE
agents; develop a public information mechanism for rumor
control and apprehension retardant; perform technical
analyses and reviews of reports and proposals; submit
recommendations to the Board of County Commissioners
for formal action plans by county government; review
available literature and propose alternative courses of action
for EPA consideration.
Carolawn Superfund Site Community Advisory
Board (Chester County, SC):
To ensure that the community will be included in the proper
and complete cleanup of the Carolawn Superfund Site, the
Community Advisory Board will be educated, aware and
informed and will serve as an intermediary between EPA,
South Carolina Department of Health and Environmental
Control (SCDHEC), site response contractors and the
community at-large.
Presenting the
Mission Statement
to the Community
It is important that the Community
Advisory Group mission statement is
understood by and acceptable to the
diverse segments of your community.
Make copies of the mission statement
and distribute them to the community.
Provide an opportunity to discuss the
Community Advisory Group and its
mission statement at a public meeting.
Be willing to revise the mission state-
ment over time, as issues and commu-
nity concerns change.
Additional Resources
Information in this fact sheet is based
in part on information in Applied
Strategic Planning: An Introduction
by Leonard D. Goodstein, Timothy M.
Nolan & J. William Pfeiffer (San
Diego: Pfeiffer & Company, 1992.) To
obtain a copy, write or call Pfeiffer
& Company, 8517 Production
Avenue, San Diego, California
92121-2280. Phone: 619-578-5900
Fax: 619-578-2042. Cost information
unavailable.
Best Practices of Effective Non-
profit Organizations: A
Practitioner's Guide is available
from The Foundation Center, 79 Fifth
Avenue, Department JJ, New York,
New York 10003-3076. Cost: $29.95,
plus postage and handling. For more
information or to order by phone, call
1-800-807-3677.
-10-
September 1998
-------
Written operating
procedures spell
out how the
group will be
organized, how
it will make
decisions, resolve
disputes, commu-
nicate, and
conduct business.
Developing
operating
procedures
provides the basic
structure for how
the Community
Advisory Group
will do its work
and promotes
organizational
continuity over
time. It is a good
idea to make these
basic structure
decisions early.
^v ^^m
Operating
Procedures
September 1998
Choosing a Name
One of the first things to consider is
what you are going to call the Commu-
nity Advisory Group. Some communi-
ties choose the name Community
Advisory Group while others call
themselves task forces, boards, or
action groups.
Membership
How many people do you want on the
Community Advisory Group? Most
Community Advisory Groups have 12 to
20 members, but consider what size
group will work well for you. Do you
want a board? If so, how will the board
be selected (for example, by nominating
committee, survey, or another method)?
How will you ensure the Community
Advisory Group represents all interests?
Leadership
Will you have a chairperson, co-
chairpersons, or an executive board?
How will leadership be selected? For
-11-
how long will individual leaders serve?
What will be the duties and responsi-
bilities of the Community Advisory
Group leaders?
Meetings
Determine how often the Community
Advisory Group will meet and the
procedures for announcing and
publicizing meetings. Select a meeting
place that is convenient and neutral. You
may want to vary the meeting time and
meeting days to enable all community
residents to attend several meetings.
Be sure the Community Advisory Group
meets often enough to maintain interest
and momentum, but not so often that
meetings become non-productive or
irrelevant. Some Community Advisory
Groups meet on a regular monthly or
bimonthly basis, and allow for additional
meetings as issues arise. Decide
whether the entire community should be
invited to all the meetings. For example,
the Community Advisory Group may
meet monthly, with an entire community
meeting each quarter.
See Tool D
-------
You also will want to decide what rules
of procedure to use to guide your
meetings. Robert's Rules of Order has
long been the definitive source on
parliamentary procedure. Cannon's
Concise Guide to Rules of Order is
another, and there are others, but
Robert's Rules is, by far, the most
widely used guide.
Resolving Issues
Determine how to resolve issues within
the Community Advisory Group. Will
issues be resolved by consensus or
majority rule? Set out a decision-
making strategy, a process for setting
agendas, taking minutes, and for setting
ground rules to live by.
Example of Operating
Procedures
^A guide for developing operating
procedures is included in Part 2 of
this Toolkit for your convenience.
Although there are many questions to
be considered in formulating them,
operating procedures do not have to be
long or complicated. Following is an
example of the Operating Procedures
for the Carolawn Community Advisory
Board (CAB) in Chester County, SC:
The duration of the Community Advi-
sory Board will be three years, with
renewal every three years unless the
majority votes to discontinue. The
SeeToolD
CAB will meet no less than once every
three months. The Board will consist of
15 members. Any member that misses
two consecutive meetings will be
replaced. Members will serve for a
term of three years.
Additional Resources
Robert's Rules of Order is available
from a variety of publishers in a variety
of editions ranging in price from $4.50
to $30.00. Check any bookstore or
library for more information.
H. Cannon, Cannon's Concise Guide
to Rules of Order, (New York:
Houghton-Mifflin, 1995), Cost: $9.95.
Marjorie M. Cann, Point of Order: A
Ready Reference of Simple Rules
and Parliamentary Procedure, (New
York: Putnam Publishing, 1993). Price
information unavailable.
-12-
September 1998
-------
This section
provides
information to
help you
determine if
your Community
Advisory Group
should
incorporate. This
information will
help you get
started in
considering the
broad issues
involved, but
it is not a
substitute for
getting advice
from legal
and financial
specialists to
ensure that you
make the
most effective
decisions
for your
Community
Advisory
Group.
Incorporating
Voi/r Community
flcfvisoru Group
What Is Incorporation?
Incorporation is a process through
which an organization is granted legal
status and is recognized as an entity
under state law. An incorporated
organization has the legal right and
power to enter into contracts, own
property, borrow money, and mortgage
its property. It continues to exist legally,
even if the founders, officers, or
directors change.
What Does
Incorporation Mean for
Your Community
Advisory Group?
By incorporating, your Group adopts a
widely recognized structure and certain
operating procedures required by state
law. In addition, if you incorporate, it is
important to identify your Group as a
nonprofit organization.
The process for incorporating varies
from state to state. Consult the
corporate law of your stategovern-
ment for the specific requirements and
steps you must follow.
Advantages of
Incorporating Your
Community Advisory
Group
One of the most important advantages
of incorporating as a nonprofit
organization is that it can help your
Group qualify for financial assistance
from federal, state, public, or private
sources. For example, Groups formed
at Superfund National Priorities List
(NPL) sites must be nonprofit
corporations to be eligible for an EPA
Technical Assistance Grant (TAG).
This grant provides funds for hiring an
independent adviser who can offer
independent technical advice and
expertise to help the Community
Advisory Group participate in the
decision-making process. ^Seethe
section on "Community Advisory
Groups and Technical Assistance
Programs" for more information.
September 1998
-13-
-------
Incorporating also has other
advantages. For example, banks and
other financial institutions often view
nonprofit corporations favorably.
Incorporation also shields officers,
board members, and the employees of
a corporation from liability from debts
incurred by or legal judgments against
the corporation. Consult an attorney
for more information on the legal and
financial benefits of incorporating your
Group as a nonprofit organization.
Legal and Financial
Implications for
Community Advisory
Group Officers and
Board Members
The corporate laws in each state
include provisions defining the
responsibilities and obligations of the
corporation's officers and directors.
Directors and officers of a corporation
have a legal duty to the corporation.
They may not mix their personal affairs
with those of the corporation or act in a
way that is detrimental to it.
Corporate bylaws must designate an
officer or employee responsible for
financial reporting and tax payment.
That individual can be held personally
responsible if he or she fails to file or
pay taxes. Consult the corporate law of
your state for additional information.
Incorporating your Community
Advisory Group as a nonprofit
organization does not exempt the
Group from taxation. The Group
must file a corporate tax return (U.S.
Internal Revenue Service Form 1120)
with the federal government, even if it
takes in no revenue. The only
nonprofit corporations that do not have
to file a corporate tax return are those
that are recognized by the U. S.
Internal Revenue Service (IRS) as
"tax-exempt." Filing for tax-exempt
status is a separate process. ^See
the section on "Securing Tax-
Exempt Status" for more
information.
Most states also require nonprofit
corporations to file corporate income
tax returns, even if the nonprofit
corporation has no revenue. Some
states impose a minimum tax on any
corporation, even a nonprofit one, that
is not recognized as tax-exempt by the
IRS. Not all states impose a minimum
tax. Requirements and definitions vary
widely among the states, so it is
important to find out what your state
requires.
Procedures for
Chartering a Nonprofit
Corporation
Setting up a nonprofit corporation is
similar, but not identical, to
incorporating a for-profit business.
While the specifics vary by state,
following are some general rules:
Arranging for Incorporators
The people who will sign their
names to the legal documents
creating the corporation are
called the "incorporators."
Some states require a specific
number of incorporators.
States usually require that
incorporators be adults (at least
18 or 21 years old depending
on the state) and that a
majority be citizens of the United
States. The incorporators are
recognized as the founders of the
corporation.
Selecting a Board of Directors
The incorporators must
establish a board of trustees
or directors. The minimum number
of directors (usually three) is
specified by law. Again, legal
qualifications are minimal: directors
usually must be adults under state
law, and some or all of them must
be U.S. citizens. Incorporators
may be named as directors at the
time of incorporation but are
required to serve only until the first
annual meeting of the corporation.
At this meeting, additional directors
may be elected or a new board
may be selected.
-14-
September 1998
-------
Drafting Articles of
Incorporation
The prescribed format for
Articles of Incorporation is set
out in state corporate law.
Generally, these laws require
that the Articles of Incorporation
include:
the title and number of the
state law that governs
incorporation of a nonprofit
organization (available from the
state's Secretary of State);
the name of the organization to
be incorporated;
a statement of the purpose
(mission statement) of the
organization, indicating the
charitable, educational, social,
religious, or other beneficial,
nonprofit goal the corporation
intends to achieve and stating that
financial gains from the
corporation's activities will not be
distributed as dividends or profit
shares to directors, officers, or
members of the organization;
the location of the corporation's
office, the place from which
activities will be directed and
where records will be kept;
names and home addresses of
people named as directors;
a statement that incorporators
meet whatever requirements are
stipulated in the state's corporation
law; and
signatures and addresses of the
incorporators (signatures may
have to be notarized). Additional
legal statements may be required
by some states.
Filing the Certificate and
Fee Payments
The Articles of Incorporation,
other required documents, and
filing fees must be submitted to the
state agency responsible for
granting corporate charters. In
most states, this is the Secretary of
State, state corporation
commission, or a similar agency.
Notice of Acceptance and Filing
The appropriate state agency will
acknowledge by mail receipt of your
application. As soon as this
certificate is issued, the corporation
legally exists and can start operating.
Steps for Incorporating
a Community Advisory
Group
1. Contact the state agency
responsible for incorporation of
nonprofit organizations.
In most states, the corporate
division of the Secretary of State is
responsible for incorporation of
nonprofit organizations. Other states
have corporate commissions, or
maintain corporate divisions in
departments regulating commerce
and business affairs. Telephone
numbers for these offices often are
listed in the "State Government"
section of your local telephone
directory or are available in public
libraries.
The appropriate state agency will
provide information on state laws
governing incorporation, and tell you
how to obtain legal forms and
complete requirements for filing them.
2. Define the purpose of
the corporation.
Writing a mission statement
provides the basis of the
organization's charter as a nonprofit
corporation. This statement is
essential for establishing the
organization's identity as a nonprofit
corporation.
3. Complete forms and draft other
required documents.
Arrange for incorporators
Select a board of directors
September 1998
-15-
-------
Draft a constitution or set
ofbylaws
Draft Articles of Incorporation
Draft other required documents
It is a good idea to retain an attorney
to help prepare and file your
corporate charter, or review your
application package before you submit
it to the state.
Additional Resources:
Ted Nicholas, The Complete Guide to
Nonprofit Corporations: Step-by-
Step Guidelines, Procedures and
Forms to Maintain a Nonprofit
Corporation (Chicago: Enterprise-
Dearborn, 1993). Cost: $19.95.
Submit paperwork and required fees
to the state's incorporating agency.
Required fees vary from state to
state, but generally they are less
than $100. In some states, fees are
considerably lower. Check with the
state's incorporating agency, a local
certified public accountant, or your
attorney to find out the applicable
fees in your state.
The incorporating agency eventually
will return a certified copy of the
certificate of incorporation. Once
this certificate is issued, the
corporation is in business and can
begin operating.
-16-
September 1998
-------
This section
provides
information to
help you
consider whether
your Community
Advisory Group
should seek
tax-exempt status.
It complements
the information
about
incorporation in
the previous
section. While this
information
will help you
get started in
considering the
broad issues
involved, it is
not a substitute
for getting
advice from
legal and
financial
specialists.
Seci/r/ag
Status
What is Tax-Exempt
Status?
Section 501(c) of the U.S. Internal
Revenue Code exempts from taxation
certain types of organizations that serve a
special and useful purpose. Virtually all
nonprofit corporations, except churches
and church-related groups, must apply to
the IRS for recognition of their tax-
exempt status. Unless they obtain tax-
exempt status from the IRS, nonprofit
corporations must file a corporate tax
return (IRS Form 1120) with the
federal government each year, even if
the group takes in no revenue.
It also may be necessary to file
applications with state and local
authorities to obtain exemption from
state and local taxes; however this
designation usually is automatic based on
the IRS ruling.
September 1998
-17-
Advantages of Tax-
Exempt Status
There are several distinct advantages
to securing tax-exempt status from the
IRS:
Once tax-exempt status is formally
recognized by the IRS, the income
and assets of the nonprofit corporation
are free from federal taxation and,
usually, from state and local taxation,
too.
Certain classifications of tax-exempt
status provide the nonprofit corporation
with legal authority to accept
contributions, and permit contributors to
deduct their donations from income
tax.
A tax-exempt, nonprofit corporation
also may apply to the U.S. Postal
Service for a special permit for lower-
rate postal privileges.
See Tools E and F
-------
Tax-Exempt
Classifications Under the
Internal Revenue Code
Section 501(c) of the Internal Revenue
Code includes more than 20
classifications of organizations eligible
for tax-exempt status. Most of them do
not pertain to Community Advisory
Groups. The most appropriate
classification for Community Advisory
Groups is designation as a charitable
organization as defined under Section
501(c)(3) ofthe Internal Revenue Code.
This classification allows the organization
to solicit financial support from the public
and to receive government grants and
support from public and private
foundations.
Nonprofit corporations must meet
several standards to qualify for tax-
exempt status under Section 501 (c)(3):
The organization must organize and
operate exclusively for one or
more ofthe special purposes
specified under Section 5 01 (c).
These include religious,
educational, charitable, scientific,
or literary purposes; testing for
public safety; or other specific
purposes outlined in the law.
None of the net earnings or
revenues ofthe organization can
be distributed for the private
benefit of individuals or shareholders.
See Tools E and F
The organization cannot engage in
lobbying (defined as attempting to
influence legislation) as a
substantial part of its activities.
Participation in political campaigns
or on behalf of any candidate is
strictly prohibited.
A nonprofit corporation must provide
evidence that it meets these criteria in
its bylaws and Articles of Incorpor-
ation. It also must demonstrate that the
eligibility criteria are met by docu-
menting its actual operations and
activities in annual filings with the IRS.
How To Secure Tox-
Exempt Status for Your
Community Advisory
Group
To obtain tax-exempt status, it is
necessary to apply to the Internal
Revenue Service for an advance
(temporary) or a definitive (permanent)
ruling.
Advance Ruling: If your Community
Advisory Group is just getting off the
ground, you may seek an advance
ruling from the IRS, which grants
temporary tax-exempt status that is
valid for two or three years, while you
get organized. In your application, the
IRS will require you to describe the
operations of your nonprofit
corporation in sufficient detail to allow
them to determine if the proposed
activities clearly will meet the
requirements for tax exemption. The
application form provides space to
describe the activities the Community
Advisory Group anticipates, its sources
of funding, and the kinds of expenditures
expected.
During the time covered by the
advance ruling, the organization is
considered a tax-exempt organization
and is expected to demonstrate by its
record that it is operating in a way that
-18-
meets IRS requirements for charitable
organizations under Section 501(c)(3).
Then, you can apply for a definitive
(permanent) ruling. If the organi-
zation's record during the period ofthe
advance ruling does not support its
claim, it will be held liable retroactively
for some taxes, although income from
contributions during that time will not
be affected.
Definitive Ruling: If your Community
Advisory Group has been in operation
for several months, you may apply for
a definitive ruling, which grants per-
manent tax-exempt status. In your
application, the IRS will require you to
supply detailed information about your
organization's operations to demon-
strate that it meets the eligibility
requirements enumerated under
Section 501(c)(3).
September 1998
-------
Procedure for Securing
Tax-Exempt Status for a
Community Advisory
Group
1. Obtain the required forms from
the IRS.
You will need IRS Form 1023,
Application for Recognition of
Exemption Under Section
501(c)(3) of the Internal Revenue
Code. *°A copy of this form and
the IRS instructions for applying
are provided in Part 2 of this
Toolkit for your convenience.
Your Community Advisory Group
also must have an Employer
Identification Number (BIN)
whether or not it has employees or
plans to hire any. You can file IRS
Form SS-4, Application for
Employer Identification Number,
at the same time you file an
application for tax-exempt status.
*°A copy of this form and the
IRS instructions on how to
complete it are provided in Part
2 of this Toolkit for your
convenience. In most cases, you
can submit applications by mail and
by facsimile (FAX). The IRS Office
in your area can provide the local
FAX number.
September 1998
2. Define the purpose of the
organization.
A written mission statement is
essential for establishing the
organization's identity as a nonprofit
corporation and obtaining tax-
exempt status under federal and
state law. For the purposes of
qualifying for tax-exempt status, the
statement should include:
Information on how the
organization will meet the
eligibility criteria to qualify for tax-
exempt status under Section
501(c)(3), that is, how it will
organize and operate exclusively
for one or more of the special
purposes specified under Section
501(c);
A statement that no part of the net
earnings of revenues of the
organization will be distributed for
the private benefit of individuals or
shareholders; and
A statement that the organization
will not engage in lobbying
(defined as attempting to
influence legislation) as a
substantial part of its activities,
and will not participate in any way
in political campaign activities.
IRS Publication 557, Tax-
Exempt Status for Your
Organization provides useful
information for drafting this
statement.
3. Submit necessary forms and
supporting documents to the
IRS for tax-exempt status.
Submit your IRS Form 1023,
Application for Recognition of
Exemption Under Section
501(c)(3) of the Internal
Revenue Code, and IRS Form
SS-4, Application for Employer
Identification Number to the
-19-
appropriate IRS Regional office.
Be sure to include all necessary
supporting documents.
It is always a good idea to have an
attorney or accountant help prepare
your application or review the
documents before you submit them to
the IRS.
Additional Resources:
U.S. Internal Revenue Service
Publication 557, Tax-Exempt Status
for Your Organization. FREE. Find
the address of the nearest Internal
Revenue Service Office in the "United
States Government" section of your
local telephone directory. Many IRS
publications and forms also are available
on the Internet at www.irs.ustreas.gov.
See Tools E and F
-------
-20-
-------
In order to
make informed
decisions,
Community
Advisory Groups
need access to
reliable technical
advice and
expertise.
Although experts
may exist in some
Community
Advisory Groups,
most groups will
need to engage
the services of an
independent
technical advisor.
Receiving good
technical advice
is fundamental to
an effective
Community
Advisory Group.
Co/n/nu/i/ty fldv/sory
Group
Programs
Sources of Technical
Assistance
Community Advisory Groups may get
technical assistance from several
sources. At the city, county, state, or
federal level, grants and contracts may
be available to fund technical advisors.
At the federal level, Community
Advisory Groups at sites listed on the
Superfund National Priorities List
(NPL) may qualify to apply for a grant
to hire a technical advisor through the
EPAs Superfund Technical Assistance
Grant, or TAG, program. For sites not
listed on the National Priorities List,
Community Advisory Groups may
receive technical assistance through
EPAs Technical Outreach Services for
Communities (TOSC) program.
Superfund Technical
Assistance Grant
Program
The Technical Assistance Grant
program was established to promote
public involvement in Superfund site-
specific cleanup strategies. Through
the Technical Assistance Grant pro-
gram, grants of up to $50,000 are
provided to qualified citizens' groups to
hire independent technical advisors.
The role of the technical advisor is to
help citizens understand and comment
on site-related information, thereby
ensuring citizen participation in cleanup
decisions. Community Advisory Groups
must meet the same requirements as
other groups to be eligible for a Techni-
cal Assistance Grant.
Superfund Technical
Assistance Grant
Program Requirements
Community Advisory Groups and other
citizens' groups that want to apply for
Technical Assistance Grants must
meet four basic requirements:
The group applying for a Technical
Assistance Grant must be nonprofit
and incorporated.
September 1998
-21-
See Tools G and H
-------
The group is required to contribute
matching funds, whether in cash or
in donated services or supplies,
equal to 20 percent of the total
project costs.
The group must state what it
intends to do with Technical
Assistance Grant funds.
Only one Technical Assistance
Grant recipient may exist at a time
for each Superfund National
Priorities List site.
The following groups are not eligible
for grant funds:
Potentially responsible parties,
which include individuals, munici-
palities, or companies (such as
facility owners or operators, or
transporters or generators of
hazardous waste) potentially
responsible for, or contributing to,
the contamination problems at a
Superfund site;
Academic institutions;
Political subdivisions; and
Groups, such as counties or cities,
established or supported by
government.
This means that the membership of the
Community Advisory Group cannot
See Tools G and H
include government officials acting in
their official capacity. For example, if
the town mayor is a member of the
Community Advisory Group and
represents the town in his or her official
capacity as mayor, the group is not
eligible for a Technical Assistance
Grant. However, if the town mayor is
serving on the Community Advisory
Group as a concerned citizen, the group
is eligible for a Technical Assistance
Grant. The same reasoning applies to
potentially responsible parties and other
groups listed above as not eligible.
Applying for a
Technical Assistance
Grant
Community Advisory Groups may take
advantage of a Technical Assistance
Grant in three ways. They may apply
for a Technical Assistance Grant
themselves, become part of a coalition
applying for a Technical Assistance
Grant, or work with a group that
already has received a Technical
Assistance Grant.
Applying For Your Own Technical
Assistance Grant
To see if your Community Advisory
Group qualifies to apply for its
own Technical Assistance Grant,
answer the following questions.
1. Is your site on EPAs Superfund
National Priorities List?
The National Priorities List
contains approximately 1,400
of the most serious hazardous
waste sites across the nation.
All of the sites are potential
threats to the environ ment.
Technical Assistance Grants
are available only at proposed
or final National Priorities List
sites.
2. Is your Community Advisory
Group a nonprofit corporation?
Any group applying for a Technical
Assistance Grant must be nonprofit
and incorporated (that is, form a
legal corporation) or be working
toward incorporation under appli-
cable state laws.
If your Community Advisory Group
is not currently a nonprofit corpora-
tion, there are steps you can take
now to meet this qualification. *°See
the section on "Incorporating
Your Community Advisory
Group" for more information.
3. Has a Technical Assistance Grant
already been awarded to another
group for your site?
Only one Technical Assistance
Grant may be awarded at a time
for each Superfund National
-22-
September 1998
-------
Priorities List site.
4. Does your Community Advisory
Group receive financial or other
support from any of the following
groups?
Support from any of the following
groups makes you ineligible for a
Technical Assistance Grant.
Potentially responsible parties,
which includes individuals, munici-
palities, or companies (such as
facility owners or operators, or
transporters or generators of
hazardous waste) potentially
responsible for, or contributing to,
the contamination problems at a
Superfund site.
Academic institutions.
Political subdivisions (such as
counties or cities) or other groups
established or supported
by government.
If the answers to questions 1 and 2 are
"YES," AND the answers to questions
3 and 4 are "NO," your Community
Advisory Group may qualify to apply for
its own Technical Assistance Grant. If
your Community Advisory Group does
not qualify, consider joining a coalition
to apply for a Technical Assistance
Grant or working with an existing
Technical Assistance Grant group.
*°A copy Gf Superfund Technical
September 1998
Assistance Grant (TAG) Handbook:
Applying For Your Grant is provided
in Part 2 of this Toolkit for your
convenience.
Forming Coalitions To
Apply For a Technical
Assistance Grant
Coalitions may be formed for different
reasons. If several citizens' groups
exist in a community that has a Na-
tional Priorities List site and they all
express an interest in applying for a
Technical Assistance Grant, EPA
encourages the groups to form a coali-
tion. If a Community Advisory Group
doesn't qualify for a Technical Assis-
tance Grant, a working coalition could be
formed with another community group
that does meet the qualification criteria.
The existence of a Community Advisory
Group doesn'tpreclude the existence of
other citizens' groups atthe same site.
Working with an
Existing Technical
Assistance Grant
Recipient
If a Technical Assistance Grant
already has been awarded to another
community group, the Community
Advisory Group is encouraged to form
a coalition with the Technical
Assistance Grant group. Commu-
nity Advisory Groups and Techni-
cal Assistance Grant groups
should work together toward
common goals with respect to site
cleanup. One way to achieve this
coordination is by having some
members of each group belong to
both groups.
For example, the Community
Advisory Group at the Oronogo-
Duenweg Mining Belt Superfund
site in Missouri, which is called
the Jasper County EPA
Superfund Citizen's Task Force,
-23-
has a good working relationship with a
separate group that has been awarded
a Technical Assistance Grant. The
constant flow of information between
the two groups is provided by two
members who belong to both.
hi this case, the Community Advisory
Group also has its own technical
advisor (paid for by the city of Joplin)
who shares information with the
Technical Assistance Grant group's
technical advisor.
Uses of Technical
Assistance Grants
Citizens' groups use Technical Assis-
tance Grant funds to hire technical
advisors to help the group understand
existing information about the site or
information developed during the
Superfund cleanup process.
Technical advisors may:
Review site-related documents,
whether produced by EPA or others;
Meet with the Technical Assis-
tance Grant group to explain
See Tools G and I
-------
technical information;
Provide assistance in communicating
the group's site-related concerns;
interpret technical information for
the community;
Participate in site visits, when
possible, to gain a better
understanding of cleanup activities;
Travel to meetings and hearings
related to the situation at the site; and
Attend required health and
safety training.
Technical Assistance Grant funds may
be used to hire someone to administer
the grant; however, using funds in this
manner reduces the amount of funds
available for technical assistance and
those costs become part of the current
20 percent cap on administrative costs.
Grant groups considering this option
should examine whether their grant
administration methods could be met
through volunteer efforts. Please note
that the Technical Assistance Grant
regulation is being revised. One item
that may change is the cap on adminis-
trative costs. Check with your Techni-
cal Assistance Grant coordinators for
further information.
You cannot use Technical Assistance
Grant funds to develop new information
(for example, to conduct additional
sampling) or, in any way, to support legal
actions, including preparation of testi-
mony or hiring of expert witnesses.
Technical Outreach
Services for
Communities (TOSC)
The Technical Outreach Services for
Communities program was established
to provide technical assistance to
citizens and citizens' groups who do
not qualify for Technical Assistance
Grants. The Technical Outreach
Services for Communities program
provides Superfund grant monies to a
national network of Hazardous Sub-
stance Research Centers. The Centers
are made up of experts in environmen-
tal science and engineering from 29 of
the nation's leading univeristies. The
Centers' experts provide independent
scientific and technical advice to
communities on a variety of topics
related to hazardous substances,
including potential health effects,
environmental risks, cleanup options
available, and regulatory con-
cerns. *°A copy of Technical
Outreach Services for Commu-
nities is provided in Part 2 of
this Toolkit for your conve-
nience.
The Technical Outreach Services
for Communities program does
not require you to file an applica-
tion to obtain help. However, the
type of services available and
how to make arrangements to
receive assistance varies. A list
of regional contacts for the Technical
Outreach Services for Communities
program is included in the brochure in
Part 2 of this Toolkit. You may contact
these individuals or the Community
Involvement Coordinator in your EPA
Regional Office to learn more about
the specific services available to your
Community Advisory Group.
Finding Other Sources
of Funding for Technical
Assistance
Funding to hire a technical advisor may
be available through not only EPA's
programs but also other federal, state,
and local sources.
For example, the Community Advisory
Group at the Colorado School of Mines
Research Institute hazardous waste
removal action site in Golden, Colo-
rado, called the Citizen's Working
Group, wanted to hire a technical
consultant. The group was not eligible
See Tools G and H
-24-
September 1998
-------
for a Superfund Technical Assistance
Grant because the site is not on the
National Priorities List. No other
sources of federal funding were
available. The group finally was
successful in obtaining the needed
funds from the State of Colorado
Department of Local Affairs, which
provided support through its Mining
and Energy Impacts Grant program.
The Jasper County EPA Superfund
Citizen's Task Force, on the other
hand, has a technical advisor who was
hired by the City of Joplin to provide
advice on EPA documents and actions.
Community Advisory Group members
and federal, state, and local govern-
ment officials who work with your
group may be able to suggest other
sources of funding for technical
assistance.
Additional Resources
Superfund Technical Assistance
Grants Fact Sheet (EPA 540-K-93-
001 orPB93-963301) is available from
EPAs National Center for Environ-
mental Publications and Information,
P.O. Box 42419, Cincinnati, Ohio
45242. FREE. Orders also may be
faxed to 513-489-8695. Be sure to
include the EPA publication number
listed after the title with these orders.
The publication also may be purchased
from the National Technical Informa-
tion Service (NTIS) by calling 703-
September 1998
487-4650. Use the PB number listed
after the title to order from NTIS.
How to Find, Choose and Hire a
Technical Advisor (EPA 540-K-95-
004) is available from EPAs National
Center for Environmental Publications
and Information (see ordering informa-
tion above). FREE.
-25-
See Tools G and H
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-26-
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Where can
Community
Advisory Groups
find funds to
support their
work? The answer
may surprise you.
While most people
look first to the
federal government
or to national
charitable
foundations,
most funding
is found closer
to home.
f/'/ic/ing
for Co/n/ni/n/ty
flc/v/soru Group.
Local companies, major retailers, and
even small businesses are potential
contributors to Community Advisory
Groups. There also are voluntary service
organizations and the scores of small,
local foundations and plant-level corpo-
rate-giving programs eager to support
worthwhile local programs.
Thinking locally is very important,
because even getting funds from state
and federal sources often depends on
making contacts at the local level first.
The key is to talk to people at the local
level who can help you identify potential
funding sources, and to form partnerships
with local agencies and organizations
with direct access to potential funders.
Creating Local
Partnerships
Without a doubt, the local community is
the best source of funding and other
support for Community Advisory Group
activities. Many local companies and
organizations are eager to support
worthwhile community projects. Often,
all you have to do is ask.
hi identifying prospects, look for:
Subsidiaries and local plants
connected to major corporations;
Major employers;
Major retail outlets;
Major small businesses located in
or serving the affected area;
Insurance companies, health
maintenance organizations, and
health care companies; and
Local foundationssuch as you
city's "Community Foundation" or
small foundations that restrict funding
to local projects. The reference
librarian at the local library can
direct you to a listing of these.)
September 1998
-27-
SeeToolA
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The best prospects are companies that:
Are doing well financially;
Have reputations for being " good
corporate citizens";
Already support projects in
the community; or
Have a natural tie-in with environ-
mental issues, the affected area, or
the affected population groups.
Identifying Potential Funders
Chances are that one or more compa-
nies in your community come to mind
immediatelyand there probably are
others. Ask around. Talk to people who
can help you identify companies that
may be potential funders.
A good place to start is among Com-
munity Advisory Group members
themselves. Does anyone on the
Community Advisory Group have ties
to the potential funder? Does he or she
know someone who does? You also
can talk to leaders from the Kiwanis
Club, Lions, Rotary, and other local
service organizations. Many of these
groups have close ties with the local
business community and raise funds to
support worthwhile community
projects. Call the Chamber of Com-
merce and talk with someone who can
share his or her knowledge of the local
business community.
Suggest coffee or ask for a short,
informational meeting to introduce
yourself and the Community Advisory
Group. Briefly explain what you are
trying to accomplish. If you can, outline
one or more specific projects for which
you are seeking support. Ask a leader
from the Kiwanis, Lions, Rotary Club,
or Chamber of Commerce if their
group would be willing to directly
supportyour activities, but don't stop
there.
It is equally important to ask for
referrals and introductions to other
prospects. Does he or she know any
other organizations or companies that
might support your work? Who is the
key person with whom you should talk?
Would he or she be willing to make a
phone call or to introduce you to the
people you need to talk to?
Introductions to other potential funders
are extremely important, because most
local funding decisions are made based
on personal relationships. Avoid making
"cold calls" to potential funders. It is
much better to talk to someone you
know personally or to whom you have
been personally referred, and have him
or her introduce you the most appropri-
ate contact.
Contacting Prospective
Funders
Once you have identified a
prospect and an appropriate
contact person, ask for a short
introductory meeting to learn
more about the company's giving
programs. Be prepared to make
a short but effective case that
"sells" the Community Advisory
Group's value to the community.
Be specific. It is much easier to
get funding for specific purposes
than for general support.
Describe one or more projects for
which you are seeking support. For
example, you might explain that the
Community Advisory Group wants to
increase
community participation in the decision-
making process and is seeking $500 to
start a newsletter, or to mail some
information that will help accomplish
that goal. Ask if the company would
consider a funding request. To whom
should the request be directed? Is there
an application to fill out or a specific
proposal format you must use? When
is the best time to apply?
Don't overlook opportunities to seek
and receive non-cash support in the
form of donated property, services, or
volunteer hours. Often this support can
be as valuable as cash. *°See the
"Meet the Community Advisory
Group" section for more informa-
tion on how businesses and others
in the community can provide this
kind of support.
Funds from local companies usually are
awarded at the discretion of the local
plant manager, the director of public or
community relations, the government
SeeTool A
-28-
September 1998
-------
relations office, or a local committee.
A complicated application usually is not
required. However, you should prepare
a short, written proposal that explains
how your program will effectively
address a critical problem. Preparing a
good proposal is the single most
important step you can take to attract
funding to your Community Advisory
Group. ^Information on how to
write a proposal is provided in Part
2 of this Toolkit for your conven-
ience.
Developing ongoing personal relation-
ships with the people who make
funding decisions is critical. Keep up
the contacts you have made. Touch
base on a regular basis, even if your
first meeting did not result in success.
Something could come up later, or he
or she could provide an important lead
in the future.
Funding from Federal
and State Governments
Federal and state funding sources are
very limited, and eligibility often is
restricted to certain agencies and
organizations. However, your Commu-
nity Advisory Group can overcome this
by forming a partnership with an
agency that is eligible. The key is being
flexible and creative in your approach
tofundraising.
The best way to find and obtain federal
and state funds is through local
networking. Talk to people in the
community who are likely to know
about federal or state programs. The
best prospects are local elected
officials and their staffs. Also contact
local agencies that work on the same
kinds of issues as the Community
Advisory Group. The environmental
engineering or environmental education
departments of a local college or
university also can provide potential
leads.
Schedule a brief meeting to introduce
these local contacts to the Community
Advisory Group. Ask if they know of
any federal or state programs that
address goals and objectives similar to
yours. Ask for referrals. Are there
project ideas that you can work on
together as a team? Who else should
you talk to? Would your contact help by
introducing you to these other people?
Identifying Sources of Federal and
State Funding
There are only a few federal and state
programs that make grants directly to
local community organizations. One
example is the "Health Connection
Project" sponsored by the National
Institutes of Health (NIH)
National Center for Research
Resources. Grants of up to
$10,000 are available to coalitions
of religious and/or community
groups for health education
programs. For more information,
contact Brenda Files or Edward
Gonzales of the American
Association for the Advancement
of Science at 202-326-6783 or
e-mail: bfiles@aaas.org.
Keep in mind that this and other
government grant programs are
subject to funding by Congress,
and most have a limited duration. Grants
may be offered only on a one-time basis
or only over a short period.
Community Advisory Groups are not
eligible to apply directly for most
federal or state programs. But, certain
local agencies are eligible to apply. Find
out who they are and team up with
them. Sometimes, they will include
your project in their funding application
or can support your efforts directly
using the funds they receive. This is an
excellent opportunity to build strong
working relationships with key local
and state agencies.
For example, the federal Community
Development Block Grant (CDBG)
program provides funds to promote
urban development and provide decent
housing and a suitable living environ-
ment. CDBG funds support a variety
of community economic development
and housing-related projects and
provide economic opportunities for
low- and moderate-income people.
Funds are awarded to metropolitan
cities and urban counties, or to the
states for rural areas. They, in turn,
September 1998
-29-
SeeToolA
-------
support projects undertaken by
local governments and private
"subgrantees." Generally, the city or
county department of housing or
community development is the local
agency eligible for funding. Start by
making contacts with people in these
agencies.
Is your site located in a federally or
state-designated Empowerment Zone
(EZ), Enterprise Community (EC),
Supplemental Empowerment Zone or
Enhanced Enterprise Community? If
so, there may be funding available
through the federal government's EZ/
EC Program for some Community
Advisory Group activities. These
designations also can trigger access to
a variety of other federal and state
programs that promote economic
development and empowerment in
designated areas with pervasive
poverty, unemployment and general
duress. Strong community participation
is a major emphasis.
Community-based organizations,
businesses, schools, and service
organizations serving these EZ/EC
areas may be eligible to participate in
the community development plan and
receive support for community and
neighborhood revitalization projects.
Similar programs funded by individual
states exist in many areas. Contact
your housing and community develop-
ment departments to see if your
community qualifies and to get more
information.
If your Community Advisory Group is
dealing with health education or public
health issues, you also should contact
your local health department and social
service agencies. These agencies can
tap into a number of federal and state-
funded public health-related programs.
For example, the Centers for Disease
Control of the U.S. Public Health
Service offers grants for public health
programs in specific categories.
Contact your local health department to
see if health education activities or
other health-related activities could
qualify for support.
State and local departments of health
can apply for funding under the Mater-
nal and Child Health Block Grant to
address health-related issues for low-
income women and children. Commu-
nity organizations can receive
subgrants for local programs that
promote childhood health, particularly
among low-income populations.
The Preventive Health and Health
Services Block Grant supports a number
of preventive health services and educa-
tional programs. Here, too, local nonprofit
community organizations may qualify for
subgrants for projects that meet the
objectives of the overall program.
Contact your local health department or
social service department.
Local community action agencies
(CAAs) receive funding through the
federal Community Services Block Grant
program and other federal and state
programs targeted to low-income
people. These local social service
agencies can become allies for Commu-
nity Advisory Groups in many communi-
ties. Many CAAs have experience
promoting community participation and
could be excellent partners in your
environmental education and community
outreach efforts. CAAs have many
different names: community action or
economic opportunity programs, boards,
or commissions are most common. If
you are unable to find a local listing, the
National Association of Community
Action Agencies can help you. Call
them at (202) 265-7546.
The Federal Surplus Property Program
makes available to local governments,
educational institutions and nonprofit
organizations federal surplus property
from fire trucks to office machines.
Property must be used for public
purposes. Contactyour state's surplus
property agency to inquire about
eligibility and about items available at
anytime.
National Foundations
and Corporate Giving
Programs
There are nearly 25,000 grants-making
foundations in the United States.
Competition for these grants can be
stiff, and proposed projects usually
mustfall into specific categories.
Once again, it is on the local level that
most of the action takes place. Large
SeeTool A
-30-
September 1998
-------
well-known foundations and corpora-
tions have more money to give away
and make larger grants, but they
comprise only a small part of the
foundation picture. The vastmajority of
foundations are quite small and limit
giving to certain geographical areas.
Most corporate giving programs
restrict funding to projects in areas in
which they maintain plants, and grants
are made at the local-plant level rather
than by the corporate headquarters.
There are a few small national founda-
tions that are potential funders for
Community Advisory Groups. For
example, the Ben & Jerry's Foundation
supports community-based and envi-
ronmental programs, including those
that promote public participation.
Contact the nearest Ben & Jerry's Ice
Cream store for more information. The
National Environmental Education and
Training Foundation provides grants to
local community-based organizations to
support projects promoting informed
local environmental decision-making
and to leverage funding from other
sources. Call 202-628-8200 for applica-
tion guidelines.
An important factor to consider before
exploring foundation funding is that this
funding usually is restricted to nonprofit
organizations with a 501(c)(3) designa-
tion from the Internal Revenue Ser-
vice. Some corporate giving programs
may have less stringent restrictions.
The key to accessing foundation and
corporate funding is doing your
homework. Again, the best place to
start is by networking locally and asking
people who may be familiar with
potential funders. After that, the next-
best place is a Foundation Center
Library. Foundation libraries are
maintained in New York, Washington,
B.C., and other major cities, andina
number of major universities. For the
location of the nearest Foundation
Center Library, contact the Foundation
Center Library Services, 79 Fifth Ave.,
New York, New York 10003-3076,212-
620-4230.
The Foundation Center libraries are
easy to use. You can view a short
training video that shows you how to
use the reference materials. Start by
identifying foundations with an interest
in your subject area and which make
awards in your geographical area.
Look at information for each potential
foundation individually to see if your
project fits into their funding profile. If
there is a good fit, write or call each
foundation directly to request applica-
tion guidelines.
Additional Resources:
Guide to Proposal Writing by Jane C.
Geever and Patricia McNeill is avail-
able from The Foundation Center, 79
Fifth Avenue, Department JJ, New
York, New York 10003-3076. Cost:
$34.95, plus postage and handling. For
more information or to order by phone,
call 1-800-807-3677.
The nine-part Nonprofit Management
Series, available from Independent
Sector Publications, includes an
individual publication on Fundraising
(#7). Cost: $5.00eachforindividual
publications, or $35.00 for the nine-
volume set, plus postage and handling.
Call Independent Sector Publications at
301-490-3229 formore information or
write to them at Independent Sector
Publications, P.O. Box 451, Annapolis
Junction, Maryland 20701.
September 1998
-31-
SeeToolA
-------
-32-
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Community Tools
How To Write a Proposal Al
Community Advisory Group: Our Voice in EPA
Decisions [Presentation] Bl
Community Advisory Group: Our Voice in EPA
Decisions [Script Notes] Cl
Operating Procedures Dl
IRS Form (SS-4) for Applying for Employer ID El
IRS Instructions and Forms (1023, 872-C, and 8718)
for Applying for Recognition of Tax-Exempt Status Fl
Superfund Technical Assistance Grant (TAG)
Handbook: Applying for Your Grant Gl
Technical Outreach Services
for Communities......................................... HI
-------
How To
Write a
Proposal
September 1998
-TOOIAI-
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-Tool/12-
-------
To "Write
a TroposaC
Cover Letter
September 1998
Finding funds to support the work of the Community Advisory Group is essential to its
long-term success. There are a variety of funding sources available to Community
Advisory Groups, ranging from local foundations and corporate-giving programs to
national charitable foundations and the federal government.
No matter what the source, getting funds usually requires developing a proposal in
which you make a case for funding the organization as a whole or a specific project.
The following is an outline for use in preparing an effective proposal, one that helps
you "sell" your idea. Each section contains several questions. Your answers to these
questions will provide the information to include in each section of your proposal.
You can find more information on how to find funding to support your Community
Advisory Group in Part 1 of this Toolkit.
Prepare a cover letter on your Community Advisory Group's letterhead. If you
do not have printed stationery, you can create your own on a computer. If that is
not possible, simply type the name and address of your Community Advisory
Group at the top of the page. In about three paragraphs, your cover letter should
summarize your request. The opening paragraph should be a sentence or two
indicating that the Community Advisory Committee is submitting the enclosed
proposal.
The middle paragraph is a short "sales pitch" to the prospective funder. This
paragraph should answer the following questions:
What is the name or title of your proposed project?
What is the dollar amount you are requesting?
What will the funding be used to do?
Will the project result in the development of a specific "product"?
If so, what?
Specifically, what will the requested funds allow the Community Advisory
Group to do?
What are the expected benefits to the community?
What are the expected benefits to the funder?
-Tool A3-
-------
Proposal
Summary
Introduction
Problem
Statement and
Assessment
of Need
September 1998
In the closing paragraph, thank the funder for the opportunity to submit the
proposal and offer to provide further information. Include a phone number and
other contact information.
Describe the key points of the proposed project in a concise paragraph. The
proposal summary, the first paragraph of your proposal, is the most important
paragraph and often is the sole basis for judgment that gets a proposal to the next
step in the review process. Answer the following questions in your summary:
What do you plan to do?
Why do you plan to do it?
How will the proposed project address a documented need in the
community?
What benefits will result? ...to the Community Advisory Group? ...to the
community?
What type of support or amount of funding are you requesting (for example,
basic organizational support, money for a specific project, "seed money" to
raise funds from other sources)?
Provide a brief introduction to the Community Advisory Group as the applicant
organization. Answer the following questions:
What is the name of the Community Advisory Group?
Does it have 501(c)(3) status from the Internal Revenue Service? (This
designation is required by most grants-making organizations.)
What is the overall purpose of the organization? (Use your Mission
Statement.)
When was your Community Advisory Group formed?
What is your basic organizational structure?
Have you had significant accomplishments or prior successes that would
add credibility to your request?
Briefly describe the site, the affected community, and the specific aspects of
the problem you plan to address. Answer these questions:
Where is the site?
What is the nature of the contamination and what conditions have resulted?
How many people are affected?
How are they affected?
What is the specific problem you are trying to address with requested
funds?
What are the reasons you have chosen to address this particular problem or
aspect of the problem? Why do you need to address the problem or aspect
of the problem?
-TOOIA4-
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Program
Objectives
Methods
Evaluation
Future Funding
September 1998
Who will benefit? How would you describe the affected community in
terms of family size and composition? Are there many families with
children?...senior citizens?...income levels? (Are there many low-income
people?) Are there specific groups within the community that will benefit
from the proposed project?
In a sentence or two, tell what outcomes are expected in terms of achievable,
measurable goals. Answer these questions:
What do you hope to accomplish?
What are the specific goals or outcomes from your proposed project?
How will what you plan to do specifically address the problems identified
in the Problem Statement and Assessment of Need?
In a couple of paragraphs, summarize what you plan to do and when you plan to
do it. Answer the following questions:
What is your overall approach or project plan?
Why did you choose this particular approach over other alternatives?
(What factors affected your decision? Has the Community Advisory Group
or another similar organization had previous experiences that support your
decision to do things in the manner you propose?)
Who will manage the project? What is his/her position in the organization?
Why is he/she qualified to manage the project?
Why do you think the methods you chose will work?
What specific activities or tasks will be necessary to accomplish your
objectives?
What is your time line for accomplishing each objective?
Describe how you will evaluate your project. Answer these questions:
What are the specific objectives or accomplishments for your project?
What specific measures will you use to determine progress towards each
objective or accomplishment?
What information will you collect for each specific measure?
Will you provide periodic progress reports to the funder? How often? What
information will be included in each progress report?
Explain how your activities will be sustained once initial funding is exhausted.
Most funders will not support a project that does not show any prospect for
continuing beyond the initial grant period. In this section, answer the following
questions:
-Tool AS-
-------
Budget
How do you plan to finance the project after the requested funding is used?
Are there other sources of funding or support for the project? If so, what
are they?
Are you raising funds from other sources? From whom? How will fundraising be
conducted?
Provide a detailed and realistic budget showing all expenditures
the program. Use the following categories as a guide:
; necessary for
Personnel/Services
Rent
Supplies
Equipment
Printing
Postage and Mailing
Travel
Telephone
Other
Labor costs, including allocated portion of salaries of
paid staff, if any, temporary help, consultants, or others
working on the proposed project.
Office space or meeting space, if applicable.
Office supplies for proposed project, and specific
supplies necessary for proposed project.
Computer, fax, phone, slide projector, video player, if
applicable. Include any special equipment to be
purchased or leased specifically for the proposed project.
Xeroxing, printing, duplicating slides, overhead transpar-
encies, etc. for presentations.
Postage, handling, shipping, and messenger services.
Local: mileage @ rate/mile, taxis, public transportation
for travel necessary for proposed project.
Non-local: mileage (a), rate/mile, rail or plane fares.
lodging and food costs for required out-of-town travel.
Cost of a phone line, long-distance calls, fax,
on-line services.
Costs and expenses not included in other categories.
September 1998
-TOOIA6-
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Community
Advisory
Group:
Oar Voice In
EPA Decisions
[Presentation]
September 1998 -JOfll B1-
-------
-TOOIB2-
-------
Community Advisory Group
Our Voice in EPA Decisions
-------
What the Community Advisory Group Is
A way for all parts of the community
to participate actively in decisions about site
cleanup and other environmental issues
-------
Why We Have One
Have a real voice in decision-making
Discuss full range of community concerns
about cleanup
Present community views and concerns to
EPA, State and Tribal agencies, others
Get up-to-date information about status of
cleanup and other activities at the site
-------
Hold meetings with community residents
Review technical information
Meet with EPA and State officials
Work together to solve environmental
problems
-------
Keys To Success
Participation by all parts of the community
Open to all viewpoints
Patience and persistence
Support from the whole community
-------
What You Can Do
Come to meetings and speak up
Encourage others to participate
Help us inform others about environmental
problems and the cleanup process
Provide information and expertise
Provide financial or other support
-------
Community
Advisory
Group:
Oar Voice In
EPA Decisions
[Script Notes]
September 1998 -TflOl C1-
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-TOOIC2-
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Community Advisory Group
Our Voice in EPA Decisions
COMMUNITY ADVISORY GROUP
Our Voice in EPA Decisions
Script Notes for Presentation
The purpose of the presentation slides is to introduce the audience to your Community
Advisory Group. Following is a replica of each slide and suggestions about the type of
information to provide in discussing each.
To be effective, keep your remarks brief; 10-15 minutes is best. Encourage people in
the audience to ask questions and leave time for answering them. These notes are to
help you plan what you want to talk about as you show each slide.
-------
What the Community Advisory Group Is
A way for all parts of the community
to participate actively in decisions about site
cleanup and other environmental issues
Slide 1
Explain the mission of your Community Advisory Group. If you have a formal
mission statement, read it to your audience. If not, briefly state the purpose for which
the Community Advisory Group was formed. Tell how many members you have, who
they are, and how they were selected.
-------
Why wmm lira
Have a real voice in decision-making
Discuss full range of community concerns
about cleanup
Present community views and concerns to
EPA, State and Tribal agencies, others
Get up-to-date information about status of
cleanup and other activities at the site
Slide 2
Explain why it is important for the community to have a voice in decision-
making. Name two or three of the most important issues or concerns that your
Community Advisory Group is working on.
-------
What We Di
Hold meetings with community residents
Review technical information
Meet with EPA and State officials
Work together to solve environmental
problems
Slide 3
Tell the audience where and how often you hold meetings with community
residents. Tell them how to find out about meetings in the future. Explain
what kinds of technical information you review and how you do that. For
example, do some members of the Community Advisory Group have technical
expertise or experience with the site that helps you? Are there other technical
experts you rely on? Do you meet or talk with EPA and State officials
regularly?
-------
Keys To Success
Participation by all parts of the community
Open to all viewpoints
Patience and persistence
Support from the whole community
Slide 4
Tell the audience that it is very important for everyone to come to Community
Advisory Group meetings and express their views. Explain that, although the
cleanup process can be long and complicated, the members of the Community
Advisory Group are committed to stick it out and will keep them informed
each step of the way. Emphasize that the community's voice in the decisions
is stronger when the whole community participates in the process.
-------
WhttYHCHDl
Come to meetings and speak up
Encourage others to participate
Help us inform others about environmental
problems and the cleanup process
Provide information and expertise
Provide financial or other support
Slide 5
This is the most important part of your message. Invite everyone to get
involved, and give them specific ideas about how they can support the
Community Advisory Group's work. Emphasize that the single most
important thing people can do is to come to meetings and express their
opinion. Let them know every citizen's view is important. Remind them
where and when the next meeting will be held. Let them know how to reach
you and other members if they cannot get to the meeting.
Suggest other ways for people to get involved. For example, long-time
residents may have information about the site and its history that may be
extremely useful. People who belong to civic and other organizations in the
community may be able to help you spread the word about your meeting dates
and times. Still others may be able to help you get the local newspaper or
television station to write about the Community Advisory Group's work.
Leave plenty of time for questions and comments from the audience. Make
sure people know how to reach the Community Advisory Group members to
get more information.
-------
Operating
Procedures
September 1998
-TOOID1-
-------
-TOOID2-
-------
Operating tproceuresor
your Community
^Advisory Qroup
NOTE: Following is a suggested format for use in preparing the Operating Proce-
dures for your Community Advisory Group. Each section contains several questions.
The answers to these questions should be the information you include in each
section of your procedures.
You can find more information on developing operating procedures in Part 1 of
this Toolkit.
Name and
Duration
Membership
Leadership
September 1998
What are you going to call the Community Advisory Group?
Will the Community Advisory Group exist for a specific period of time?
How many members will the Community Advisory Group have?
What, if any, are the special qualifications for membership?
Should the Community Advisory Group membership have a specified
composition (e.g., members from particular areas or groups in the
community)?
How will members be chosen? Will elections be held? How often?
For what term will members serve?
How will vacancies be filled?
What are the roles and responsibilities of Community Advisory Group
members?
Under what circumstances would a member be replaced? What procedures
would be used?
Will you have a chairperson or chairpersons?
Will you have an executive board? If so, what will be its composition?
How will leaders be chosen?
For what term will leaders serve?
What, if any, are the special qualifications for leadership positions?
-TOOID3-
-------
Meetings
Resolving
Issues
How will leadership vacancies be filled?
What are the roles and responsibilities of the chairperson, board
members, or other leaders?
Under what circumstances would a leader be replaced? What proce-
dures would be used?
When and how often will the Community Advisory Group meet?
Where will Community Advisory Group meetings be held?
How will meetings be announced and publicized?
Will the public be invited to all meetings?
Will you hold additional meetings for members only or other types of
special meetings?
What will be the basic format for meetings?
Will you use Robert's Rules of Order or other procedures to govern
meetings?
How will records of the meetings be kept? Will meeting minutes be
prepared?
Will minutes be made available to the public? If so, where and when?
How will members make decisions? By consensus? Majority rule?
Some other means?
Are there some decisions that can be made by the chairperson, the
board, or some other subgroup of the total membership? If so, which
ones? Under what circumstances?
How can changes to operating procedures be made?
September 1998
-TOOID4-
-------
IRS Form SS4
for Applying
for Employer
ID
September 1998 -TflOl El-
-------
-TOOIE2-
-------
Form
SS-4
(Rev. December 1995)
Department of the Treasury
Internal Revenue Service
Application for Employer Identification Number
(For use by employers, corporations, partnerships, trusts, estates, churches,
government agencies, certain individuals, and others. See instructions.)
Keep a copy for your records.
EIN
OMB No. 1545-0003
.£>
1
u
I
n
Q.
O
I
>,
*j
0)
I/I
I
Q.
1 Name of applicant (Legal name) (See instructions.)
2 Trade name of business (if different from name on line 1)
3 Executor, trustee, "care of" name
4a Mailing address (street address) (room, apt., or suite no.)
5a Business address (if different from address on lines 4a and 4b)
4b City, state, and ZIP code
5b City, state, and ZIP code
6 County and state where principal business is located
7 Name of principal officer, general partner, grantor, owner, or trustorSSN required (See instructions.)
8a Type of entity (Check only one box.) (See instructions.) ED Estate (SSN of decedent)
EH Sole proprietor (SSN) ! ! EH Plan administrator-SSN
EH Partnership EH Personal service corp. EH Other corporation (specify)
EH REMIC EH Limited liability co. EH Trust
EH State/local government EH National Guard
EH Other nonprofit organization (specify) ^-
D Other (specify) »
I I Farmers' cooperative
ED Federal Government/military ED Church or church-controlled organization
_ (enter GEN if applicable)
8b If a corporation, name the state or foreign country
(if applicable) where incorporated
State
Foreign country
9 Reason for applying (Check only one box.)
EH Started new business (specify) ^-
ED Hired employees
EH Created a pension plan (specify type)
EH Banking purpose (specify) ^-
EH Changed type of organization (specify)
EH Purchased going business
EH Created a trust (specify)
D Other (specify)
10 Date business started or acquired (Mo., day, year) (See instructions.)
11 Closing month of accounting year (See instructions.)
12 First date wages or annuities were paid or will be paid (Mo., day, year). Note: If applicant is a withholding agent, enter date income will first
13
Highest number of employees expected in the next 12 months. Note: If the applicant does
not expect to have any employees during the period, enter -0-. (See instructions.) . . . >-
Nonagricultural
Agricultural
Household
14 Principal activity (See instructions.)
15 Is the principal business activity manufacturing? .
If "Yes," principal product and raw material used
D Yes D No
16 To whom are most of the products or services sold? Please check the appropriate box.
D Public (retail) Q Other (specify) >-
Business (wholesale)
N/A
17a Has the applicant ever applied for an identification number for this or any other business?
Note: If "Yes," please complete lines 17b and 17c.
Yes
No
17b If you checked "Yes" on line 17a, give applicant's legal name and trade name shown on prior application, if different from line 1 or 2 above.
Legal name > Trade name >
17c Approximate date when and city and state where the application was filed. Enter previous employer identification number if known.
Approximate date when filed (Mo., day, year) City and state where filed Previous EIN
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.
Name and title (Please type or print clearly.)
Business telephone number (include area code)
Fax telephone number (include area code)
Signature
Date
Note: Do not write below this line. For official use only.
Please leave
blank *
Geo.
Ind.
Class
Size
Reason for applying
For Paperwork Reduction Act Notice, see page 4.
Cat. No. 16055N
Form SS-4 (Rev. 12-95)
-------
Form SS-4 (Rev. 12-95)
Page 2
General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
Purpose of Form
Use Form SS-4 to apply for an employer
identification number (EIN). An EIN is a
nine-digit number (for example,
12-3456789) assigned to sole proprietors,
corporations, partnerships, estates, trusts,
and other entities for filing and reporting
purposes. The information you provide on
this form will establish your filing and
reporting requirements.
Who Must File
You must file this form if you have not
obtained an EIN before and:
You pay wages to one or more
employees including household employees.
You are required to have an EIN to use
on any return, statement, or other
document, even if you are not an
employer.
You are a withholding agent required to
withhold taxes on income, other than
wages, paid to a nonresident alien
(individual, corporation, partnership, etc.).
A withholding agent may be an agent,
broker, fiduciary, manager, tenant, or
spouse, and is required to file Form 1042,
Annual Withholding Tax Return for U.S.
Source Income of Foreign Persons.
You file Schedule C, Profit or Loss From
Business, or Schedule F, Profit or Loss
From Farming, of Form 1040, U.S.
Individual Income Tax Return, and have a
Keogh plan or are required to file excise,
employment, information, or alcohol,
tobacco, or firearms returns.
The following must use EINs even if they
do not have any employees:
State and local agencies who serve as
tax reporting agents for public assistance
recipients, under Rev. Proc. 80-4, 1980-1
C.B. 581, should obtain a separate EIN for
this reporting. See Household employer
on page 3.
Trusts, except the following:
1. Certain grantor-owned revocable
trusts. (See the Instructions for Form
1041.)
2. Individual Retirement Arrangement
(IRA) trusts, unless the trust has to file
Form 990-T, Exempt Organization
Business Income Tax Return. (See the
Instructions for Form 990-T.)
3. Certain trusts that are considered
household employers can use the trust EIN
to report and pay the social security and
Medicare taxes, Federal unemployment tax
(FUTA) and withheld Federal income tax. A
separate EIN is not necessary.
Estates
Partnerships
REMICs (real estate mortgage
investment conduits) (See the Instructions
for Form 1066, U.S. Real Estate Mortgage
Investment Conduit Income Tax Return.)
Corporations
Nonprofit organizations (churches, clubs,
etc.)
Farmers' cooperatives
Plan administrators (A plan administrator
is the person or group of persons specified
as the administrator by the instrument
under which the plan is operated.)
When To Apply for a New
EIN
New Business.If you become the new
owner of an existing business, do not use
the EIN of the former owner. IF YOU
ALREADY HAVE AN EIN, USE THAT
NUMBER. If you do not have an EIN, apply
for one on this form. If you become the
"owner" of a corporation by acquiring its
stock, use the corporation's EIN.
Changes in Organization or
Ownership.If you already have an EIN,
you may need to get a new one if either
the organization or ownership of your
business changes. If you incorporate a
sole proprietorship or form a partnership,
you must get a new EIN. However, do not
apply for a new EIN if you change only the
name of your business.
Note: If you are electing to be an
"S corporation," be sure you file Form
2553, Election by a Small Business
Corporation.
File Only One Form SS-4.File only one
Form SS-4, regardless of the number of
businesses operated or trade names under
which a business operates. However, each
corporation in an affiliated group must file
a separate application.
EIN Applied For, But Not Received.If
you do not have an EIN by the time a
return is due, write "Applied for" and the
date you applied in the space shown for
the number. Do not show your social
security number as an EIN on returns.
If you do not have an EIN by the time a
tax deposit is due, send your payment to
the Internal Revenue Service Center for
your filing area. (See Where To Apply
below.) Make your check or money order
payable to Internal Revenue Service and
show your name (as shown on Form SS-4),
address, type of tax, period covered, and
date you applied for an EIN. Send an
explanation with the deposit.
For more information about EINs, see
Pub. 583, Starting a Business and Keeping
Records, and Pub. 1635, Understanding
Your EIN.
How To Apply
You can apply for an EIN either by mail or
by telephone. You can get an EIN
immediately by calling the Tele-TIN phone
number for the service center for your
state, or you can send the completed Form
SS-4 directly to the service center to
receive your EIN in the mail.
Application by Tele-TIN.Under the
Tele-TIN program, you can receive your
EIN over the telephone and use it
immediately to file a return or make a
payment. To receive an EIN by phone,
complete Form SS-4, then call the
Tele-TIN phone number listed for your
state under Where To Apply. The person
making the call must be authorized to sign
the form. (See Signature block on page
4.)
An IRS representative will use the
information from the Form SS-4 to
establish your account and assign you an
EIN. Write the number you are given on the
upper right-hand corner of the form, sign
and date it.
Mail or FAX the signed SS-4 within 24
hours to the Tele-TIN Unit at the service
center address for your state. The IRS
representative will give you the FAX
number. The FAX numbers are also listed
in Pub. 1635.
Taxpayer representatives can receive
their client's EIN by phone if they first send
a facsimile (FAX) of a completed Form
2848, Power of Attorney and Declaration of
Representative, or Form 8821, Tax
Information Authorization, to the Tele-TIN
unit. The Form 2848 or Form 8821 will be
used solely to release the EIN to the
representative authorized on the form.
Application by Mail.Complete Form
SS-4 at least 4 to 5 weeks before you will
need an EIN. Sign and date the application
and mail it to the service center address
for your state. You will receive your EIN in
the mail in approximately 4 weeks.
Where To Apply
The Tele-TIN phone numbers listed below
will involve a long-distance charge to
callers outside of the local calling area and
can be used only to apply for an EIN. THE
NUMBERS MAY CHANGE WITHOUT
NOTICE. Use 1-800-829-1040 to verify a
number or to ask about an application by
mail or other Federal tax matters.
Call the Tele-TIN
If your principal business, phone number
office or agency, or legal shown or file with
residence in the case of an the Internal Revenue
individual, is located in: Service Center at:
Florida, Georgia,
South Carolina
Attn: Entity Control
Atlanta, GA 39901
(404) 455-2360
New Jersey, New York
City and counties of
Nassau, Rockland,
Suffolk, and Westchester
Attn: Entity Control
Holtsville, NY 00501
(516) 447-4955
New York (all other
counties), Connecticut,
Maine, Massachusetts,
New Hampshire, Rhode
Island, Vermont
Attn: Entity Control
Andover, MA 05501
(508) 474-9717
Illinois, Iowa, Minnesota,
Missouri, Wisconsin
Attn: Entity Control
Stop 57A
2306 E. Bannister Rd.
Kansas City, MO 64131
(816) 926-5999
Delaware, District of
Columbia, Maryland,
Pennsylvania, Virginia
Attn: Entity Control
Philadelphia, PA 19255
(215) 574-2400
Indiana, Kentucky,
Michigan, Ohio, West
Virginia
Attn: Entity Control
Cincinnati, OH 45999
(606) 292-5467
Kansas, New Mexico,
Oklahoma, Texas
Attn: Entity Control
Austin, TX 73301
(512) 460-7843
-------
Form SS-4 (Rev. 12-95)
Page 3
Alaska, Arizona, California
(counties of Alpine, Amador,
Butte, Calaveras, Colusa, Contra
Costa, Del Norte, El Dorado,
Glenn, Humboldt, Lake, Lassen,
Marin, Mendocino, Modoc, Attn: Entity Control
Napa, Nevada, Placer, Plumas, Mail Stop 6271-T
Sacramento, San Joaquin, P.O. Box 9950
Shasta, Sierra, Siskiyou, Solano, Ogden, UT 84409
Sonoma, Sutler, Tehama, Trinity, (801) 620-7645
Yolo, and Yuba), Colorado,
Idaho, Montana, Nebraska,
Nevada, North Dakota, Oregon,
South Dakota, Utah,
Washington, Wyoming
California (all other
counties), Hawaii
Attn: Entity Control
Fresno, CA 93888
(209) 452-4010
Alabama, Arkansas,
Louisiana, Mississippi,
North Carolina, Tennessee
Attn: Entity Control
Memphis, TN 37501
(901) 365-5970
If you have no legal residence, principal
place of business, or principal office or
agency in any state, file your form with the
Internal Revenue Service Center,
Philadelphia, PA 19255 or call
215-574-2400.
Specific Instructions
The instructions that follow are for those
items that are not self-explanatory. Enter
N/A (nonapplicable) on the lines that do
not apply.
Line 1.Enter the legal name of the entity
applying for the EIN exactly as it appears
on the social security card, charter, or
other applicable legal document.
Individuals.Enter the first name, middle
initial, and last name. If you are a sole
proprietor, enter your individual name, not
your business name. Do not use
abbreviations or nicknames.
Trusts.Enter the name of the trust.
Estate of a decedent.Enter the name
of the estate.
Partnerships.Enter the legal name of
the partnership as it appears in the
partnership agreement. Do not list the
names of the partners on line 1. See the
specific instructions for line 7.
Corporations.Enter the corporate name
as it appears in the corporation charter or
other legal document creating it.
Plan administrators.Enter the name of
the plan administrator. A plan administrator
who already has an EIN should use that
number.
Line 2.Enter the trade name of the
business if different from the legal name.
The trade name is the "doing business as"
name.
Note: Use the full legal name on line 1 on
all tax returns filed for the entity. However,
if you enter a trade name on line 2 and
choose to use the trade name instead of
the legal name, enter the trade name on all
returns you file. To prevent processing
delays and errors, always use either the
legal name only or the trade name only on
all tax returns.
Line 3.Trusts enter the name of the
trustee. Estates enter the name of the
executor, administrator, or other fiduciary.
If the entity applying has a designated
person to receive tax information, enter
that person's name as the "care of"
person. Print or type the first name, middle
initial, and last name.
Line 7.Enter the first name, middle initial,
last name, and social security number
(SSN) of a principal officer if the business
is a corporation; of a general partner if a
partnership; or of a grantor, owner, or
trustor if a trust.
Line 8a.Check the box that best
describes the type of entity applying for
the EIN. If not specifically mentioned,
check the "Other" box and enter the type
of entity. Do not enter N/A.
Sole proprietor.Check this box if you
file Schedule C or F (Form 1040) and have
a Keogh plan, or are required to file excise,
employment, information, or alcohol,
tobacco, or firearms returns. Enter your
SSN in the space provided.
REMIC. Check this box if the entity has
elected to be treated as a real estate
mortgage investment conduit (REMIC). See
the Instructions for Form 1066 for more
information.
Other nonprofit organization.Check this
box if the nonprofit organization is other
than a church or church-controlled
organization and specify the type of
nonprofit organization (for example, an
educational organization).
If the organization also seeks tax-exempt
status, you must file either Package 1023
or Package 1024, Application for
Recognition of Exemption. Get Pub. 557,
Tax-Exempt Status for Your Organization,
for more information.
Group exemption number (GEN).If the
organization is covered by a group
exemption letter, enter the four-digit GEN.
(Do not confuse the GEN with the nine-digit
EIN.) If you do not know the GEN, contact
the parent organization. Get Pub. 557 for
more information about group exemption
numbers.
Withholding agent.If you are a
withholding agent required to file Form
1042, check the "Other" box and enter
"Withholding agent."
Personal service corporation.Check
this box if the entity is a personal service
corporation. An entity is a personal service
corporation for a tax year only if:
The principal activity of the entity during
the testing period (prior tax year) for the
tax year is the performance of personal
services substantially by employee-owners,
and
The employee-owners own 10% of the
fair market value of the outstanding stock
in the entity on the last day of the testing
period.
Personal services include performance of
services in such fields as health, law,
accounting, or consulting. For more
information about personal service
corporations, see the Instructions for
Form 1120, U.S. Corporation Income Tax
Return, and Pub. 542, Tax Information on
Corporations.
Limited liability co.See the definition of
limited liability company in the Instructions
for Form 1065. If you are classified as a
partnership for Federal income tax
purposes, mark the "Limited liability co."
checkbox. If you are classified as a
corporation for Federal income tax
purposes, mark the "Other corporation"
checkbox and write "Limited liability co." in
the space provided.
Plan administrator.If the plan
administrator is an individual, enter the
plan administrator's SSN in the space
provided.
Other corporation.This box is for any
corporation other than a personal service
corporation. If you check this box, enter
the type of corporation (such as insurance
company) in the space provided.
Household employer.If you are an
individual, check the "Other" box and enter
"Household employer" and your SSN. If
you are a state or local agency serving as
a tax reporting agent for public assistance
recipients who become household
employers, check the "Other" box and
enter "Household employer agent." If you
are a trust that qualifies as a household
employer, you do not need a separate EIN
for reporting tax information relating to
household employees; use the EIN of the
trust.
Line 9.Check only one box. Do not enter
N/A.
Started new business.Check this box if
you are starting a new business that
requires an EIN. If you check this box,
enter the type of business being started.
Do not apply if you already have an EIN
and are only adding another place of
business.
Hired employees.Check this box if the
existing business is requesting an EIN
because it has hired or is hiring employees
and is therefore required to file
employment tax returns. Do not apply if
you already have an EIN and are only
hiring employees. For information on the
applicable employment taxes for family
members, see Circular E, Employer's Tax
Guide (Publication 15).
Created a pension plan.Check this box
if you have created a pension plan and
need this number for reporting purposes.
Also, enter the type of plan created.
Banking purpose.Check this box if you
are requesting an EIN for banking
purposes only, and enter the banking
purpose (for example, a bowling league for
depositing dues or an investment club for
dividend and interest reporting).
Changed type of organization.Check
this box if the business is changing its type
of organization, for example, if the
business was a sole proprietorship and has
been incorporated or has become a
partnership. If you check this box, specify
in the space provided the type of change
made, for example, "from sole
proprietorship to partnership."
Purchased going business.Check this
box if you purchased an existing business.
Do not use the former owner's EIN. Do
not apply for a new EIN if you already
have one. Use your own EIN.
Created a trust.Check this box if you
created a trust, and enter the type of trust
created.
-------
Form SS-4 (Rev. 12-95)
Page 4
Note: Do not file this form if you are the
grantor/owner of certain revocable trusts.
You must use your SSN for the trust. See
the Instructions for Form 1041.
Other (specify).Check this box if you
are requesting an EIN for any reason other
than those for which there are checkboxes,
and enter the reason.
Line 10.If you are starting a new
business, enter the starting date of the
business. If the business you acquired is
already operating, enter the date you
acquired the business. Trusts should enter
the date the trust was legally created.
Estates should enter the date of death of
the decedent whose name appears on line
1 or the date when the estate was legally
funded.
Line 11.Enter the last month of your
accounting year or tax year. An accounting
or tax year is usually 12 consecutive
months, either a calendar year or a fiscal
year (including a period of 52 or 53 weeks).
A calendar year is 12 consecutive months
ending on December 31. A fiscal year is
either 12 consecutive months ending on
the last day of any month other than
December or a 52-53 week year. For more
information on accounting periods, see
Pub. 538, Accounting Periods and
Methods.
Individuals.Your tax year generally will
be a calendar year.
Partnerships.Partnerships generally
must adopt the tax year of either (a) the
majority partners; (b) the principal partners;
(c) the tax year that results in the least
aggregate (total) deferral of income; or (d)
some other tax year. (See the Instructions
for Form 1065, U.S. Partnership Return of
Income, for more information.)
REMIC.REMICs must have a calendar
year as their tax year.
Personal service corporations.A
personal service corporation generally
must adopt a calendar year unless:
It can establish a business purpose for
having a different tax year, or
It elects under section 444 to have a tax
year other than a calendar year.
Trusts.Generally, a trust must adopt a
calendar year except for the following:
Tax-exempt trusts,
Charitable trusts, and
Grantor-owned trusts.
Line 12.If the business has or will have
employees, enter the date on which the
business began or will begin to pay wages.
If the business does not plan to have
employees, enter N/A.
Withholding agent.Enter the date you
began or will begin to pay income to a
nonresident alien. This also applies to
individuals who are required to file Form
1042 to report alimony paid to a
nonresident alien.
Line 13.For a definition of agricultural
labor (farmworker), see Circular A,
Agricultural Employer's Tax Guide
(Publication 51).
Line 14.Generally, enter the exact type of
business being operated (for example,
advertising agency, farm, food or beverage
establishment, labor union, real estate
agency, steam laundry, rental of
coin-operated vending machine, or
investment club). Also state if the business
will involve the sale or distribution of
alcoholic beverages.
Governmental.Enter the type of
organization (state, county, school district,
municipality, etc.).
Nonprofit organization (other than
governmental).Enter whether organized
for religious, educational, or humane
purposes, and the principal activity (for
example, religious organizationhospital,
charitable).
Mining and quarrying.Specify the
process and the principal product (for
example, mining bituminous coal, contract
drilling for oil, or quarrying dimension
stone).
Contract construction.Specify whether
general contracting or special trade
contracting. Also, show the type of work
normally performed (for example, general
contractor for residential buildings or
electrical subcontractor).
Food or beverage establishments.
Specify the type of establishment and
state whether you employ workers who
receive tips (for example, loungeyes).
Trade.Specify the type of sales and
the principal line of goods sold (for
example, wholesale dairy products,
manufacturer's representative for mining
machinery, or retail hardware).
Manufacturing.Specify the type of
establishment operated (for example,
sawmill or vegetable cannery).
Signature block.The application must
be signed by (a) the individual, if the
applicant is an individual, (b) the president,
vice president, or other principal officer, if
the applicant is a corporation, (c) a
responsible and duly authorized member or
officer having knowledge of its affairs, if
the applicant is a partnership or other
unincorporated organization, or (d) the
fiduciary, if the applicant is a trust or
estate.
Some Useful Publications
You may get the following publications for
additional information on the subjects
covered on this form. To get these and
other free forms and publications, call
1-800-TAX-FORM (1-800-829-3676). You
should receive your order or notification of
its status within 7 to 15 workdays of your
call.
Use your computer.If you subscribe to
an on-line service, ask if IRS information is
available and, if so, how to access it. You
can also get information through IRIS, the
Internal Revenue Information Services, on
FedWorld, a government bulletin board.
Tax forms, instructions, publications, and
other IRS information, are available through
IRIS.
Printed on recycled paper
IRIS is accessible directly by calling
703-321-8020. On the Internet, you can
telnet to fedworld.gov. or, for file transfer
protocol services, connect to
ftp.fedworld.gov. If you are using the
Worldwide Web, connect to
http://www.ustreas.gov
FedWorld's help desk offers technical
assistance on accessing IRIS (not tax help)
during regular business hours at
703-487-4608. The IRIS menus offer
information on available file formats and
software needed to read and print files.
You must print the forms to use them; the
forms are not designed to be filled out
on-screen.
Tax forms, instructions, and publications
are also available on CD-ROM, including
prior-year forms starting with the 1991 tax
year. For ordering information and software
requirements, contact the Government
Printing Office's Superintendent of
Documents (202-512-1800) or Federal
Bulletin Board (202-512-1387).
Pub. 1635, Understanding Your EIN
Pub. 15, Employer's Tax Guide
Pub. 15-A, Employer's Supplemental Tax
Guide
Pub. 538, Accounting Periods and
Methods
Pub. 541, Tax Information on Partnerships
Pub. 542, Tax Information on Corporations
Pub. 557, Tax-Exempt Status for Your
Organization
Pub. 583, Starting a Business and Keeping
Records
Package 1023, Application for Recognition
of Exemption
Package 1024, Application for Recognition
of Exemption Under Section 501 (a) or for
Determination Under Section 120
Paperwork Reduction Act
Notice
We ask for the information on this form to
carry out the Internal Revenue laws of the
United States. You are required to give us
the information. We need it to ensure that
you are complying with these laws and to
allow us to figure and collect the right
amount of tax.
The time needed to complete and file
this form will vary depending on individual
circumstances. The estimated average time
is:
Recordkeeping .
Learning about the
law or the form .
7 min.
18 min.
45 min.
Preparing the form . . .
Copying, assembling, and
sending the form to the IRS . . 20 min.
If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form simpler,
we would be happy to hear from you. You
can write to the Tax Forms Committee,
Western Area Distribution Center, Rancho
Cordova, CA 95743-0001. Do not send
this form to this address. Instead, see
Where To Apply on page 2.
-------
IRS
Instructions
and Forms
1023, 87Z-C,
and 8718 tor
Applying tor
Recognition
of Tax-Exempt
Statas
September 1998 -TOQl F1-
-------
-TOOIF2-
-------
Department of the Treasury
Internal Revenue Service
Application
for Recognition
of Exemption
Under Section
501(c)(3) of the
Internal Revenue Code
Contents:
Form 1023 and
Instructions
Form 872-C
Note: For the addresses for filing Form 1023,
see Form 8718, User Fee for Exempt
Organization Letter Request. For obtaining an
employer identification number (EIN), see
Form SS-4, Application for Employer
Identification Number.
Package 1023
(Rev. April 1996)
Cat. No. 47194L
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Department of the Treasury
Internal Revenue Service
Instructions for
Form 1023
(Revised April 1996)
Application for Recognition of Exemption
Under Section 501(c)(3) of the Internal
Revenue Code
Section references are to the Internal Revenue Code unless
otherwise noted.
Note: Retain a copy of the completed Form W23 in the
organization's permanent records. See Public Inspection of Form
1023 regarding public inspection of approved applications.
Paperwork Reduction Act Notice.We ask for the information on
this form to carry out the Internal Revenue laws of the United States.
If you want your organization to be recognized as tax-exempt by the
IRS, you are required to give us this information. We need it to
determine whether the organization meets the legal requirements for
tax-exempt status.
The organization is not required to provide the information
requested on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as long
as their contents may become material in the administration of any
Internal Revenue law. The rules governing the confidentiality of the
Form 1023 application are covered in Code section 6104.
The time needed to complete and file these forms will vary
depending on individual circumstances. The estimated average times
are:
Form
1023 Parts I to IV
1023 Sch. A
1023 Sch. B
1023 Sch. C
1023 Sch. D
1023 Sch. E
1023 Sch. F
1023 Sch. G
1023 Sch. H
1023 Sch. I
872-C
Recordkeeping
55 hr, 29 min.
7 hr., 10 min.
4 hr., 47 min.
5 hr., 1 min.
4 hr., 4 min.
9 hr., 20 min.
2 hr., 39 min.
2 hr., 38 min.
1 hr., 55 min.
3 hr., 35 min.
1 hr., 26 min.
Learning
about the law
or the form
4 hr., 37 min.
-0- min.
30 min.
35 min.
42 min.
1 hr., 5 min.
2 hr., 53 min.
-0- min.
42 min.
-0- min.
24 min.
Preparing, and
sending the
form to IRS
8 hr., 7 min.
7 min.
36 min.
43 min.
47 min.
1 hr., 17 min.
3 hr., 3 min.
2 min.
46 min.
4 min.
26 min.
If you have comments concerning the accuracy of these time
estimates or suggestions for making these forms simpler, we would
be happy to hear from you. You can write to the Tax Forms
Committee, Western Area Distribution Center, Rancho Cordova, CA
95743-0001. DO NOT send the application to this address. Instead,
see Where To File on page 2.
General Instructions
User fee.A user fee must be paid with determination letter
requests submitted to the Internal Revenue Service. Form 8718,
User Fee for Exempt Organization Determination Letter Request,
must be submitted with this application along with the appropriate
fee as stated on Form 8718. Form 8718 may be obtained through
your local IRS office or by calling the telephone number given below
for obtaining forms and publications.
Helpful information.For additional information, get Pub. 557,
Tax-Exempt Status for Your Organization; Pub. 578, Tax Information
for Private Foundations and Foundation Managers; and Pub. 598,
Tax on Unrelated Business Income of Exempt Organizations. You
may also call 1-800-829-4477 to listen to recorded tax information. A
touch-tone telephone is required. Topic #310, Tax-exempt status for
organizations, and Topic #311, How to apply for exempt status, are
informative. These topic numbers may change. If so, listen to the
directory of topics for the new topic numbers or refer to the
instructions for a current Form 1040, U.S. Individual Income Tax
Return, for the updated list of Tele-Tax Topics. For additional forms
and publications, call 1-800-829-3676 (1-800-Tax-Form).
Purpose of Form
1. Completed Form 1023 required for section 501(c)(3)
exemption.Unless it meets either of the exceptions in item 2
below, or notifies the IRS that it is applying for recognition of section
501(c)(3) exempt status, no organization formed after October 9,
1969, will be considered tax-exempt under section 501(c)(3).
An organization notifies the IRS by filing a completed Form 1023.
Form 1023 also solicits the information that the IRS needs to
determine if the organization is a private foundation.
2. Organizations not required to file Form 1023.The following
organizations will be considered tax-exempt under section 501(c)(3)
even if they do not file Form 1023: (a) churches, their integrated
auxiliaries, and conventions or associations of churches, or (b) any
organization that is not a private foundation (as defined in section
509(a)) and that has gross receipts in each taxable year of normally
not more than $5,000.
Even if these organizations are not required to file Form 1023 to
be tax-exempt, they may wish to file Form 1023 and receive a
determination letter of IRS recognition of their section 501(c)(3)
status to obtain certain incidental benefits such as public recognition
of their tax-exempt status; exemption from certain state taxes;
advance assurance to donors of deductibility of contributions;
exemption from certain Federal excise taxes; nonprofit mailing
privileges, etc.
3. Other organizations.In applying for a determination letter,
cooperative service organizations, described in section 501 (e) and (f),
and child care organizations, described in section 501 (k), use Form
1023 and are treated as section 501(c)(3) organizations.
4. Group exemption letter.Generally, Form 1023 is not used to
apply for a group exemption letter. For information on how to apply
for a group exemption letter, see Pub. 557.
What To File
All applicants must complete pages 1 through 9 of Form 1023. The
following organizations must also complete the schedules or form
indicated:
1. Churches Schedule A
2. Schools Schedule B
3. Hospitals and Medical Research Schedule C
4. Supporting Organizations (509(a)(3)) Schedule D
5. Private Operating Foundations Schedule E
6. Homes for the Aged or Handicapped Schedule F
7. Child Care Schedule G
8. Scholarship Benefits or Student Aid Schedule H
9. Organizations that have taken over or will take over a "for
profit" institution Schedule I
10. Organizations requesting an advance ruling in Part III,
Line 11 Form 872-C
Attachments.State on each attachment that it relates to Form
1023 and identify the applicable part and line item number. Also
show on each attachment the organization's name, address, and
employer identification number (EIN). Use 81/2 by 11 inch paper for
attachments.
In addition to the required documents and statements, include
with the application any additional information citing court decisions,
rulings, opinions, etc., that will expedite processing of the
application. Generally, attachments in the form of tape recordings
are not acceptable unless accompanied by a transcript.
When To File
An organization formed after October 9, 1969, must file Form 1023
to be recognized as an organization described in section 501(c)(3).
Generally, if an organization files its application within 15 months
after the end of the month in which it was formed, and if the IRS
approves the application, the effective date of the organization's
section 501(c)(3) status will be the date it was organized.
Generally, if an organization does not file its application (Form
1023) within 15 months after the end of the month in which it was
formed, it will not qualify for exempt status during the period before
the date of its application. For exceptions and special rules,
including automatic extensions in some cases, see Part III of Form
1023.
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Where To File
File the completed application, and all information required, with the
IRS key district office for the organization's principal place of
business or office as listed in Form 8718. As soon as possible after
the complete application is received, you will be advised of the IRS's
determination and of the annual returns (if any) that the organization
will be required to file.
Signature Requirements
An officer, a trustee who is authorized to sign, or another person
authorized by a power of attorney must sign this application. Send
the power of attorney with the application when you file it. Form
2848, Power of Attorney and Declaration of Representative, may be
used for this purpose.
Deductibility of Contributions
Deductions for charitable contributions are not allowed for any gifts
or bequests made to organizations that do not qualify under section
501(c)(3). The effective date of an organization's section 501(c)(3)
status determines the date that contributions to it are deductible by
donors. (See When To File on page 1.)
Contributions by U.S. residents to foreign organizations generally
are not deductible. Tax treaties between the U.S. and certain foreign
countries provide limited exceptions. Foreign organizations (other
than those in Canada or Mexico) claiming eligibility to receive
contributions deductible by U.S. residents must attach an English
copy of the U.S. tax treaty that provides for such deductibility.
Public Inspection of Form 1023
IRS responsibilities.If the application is approved, it and any
supporting documents will be open to public inspection in any key
district office and in the Internal Revenue Service's National Office,
as required by section 6104. In addition, any letter or other
document issued by the IRS with regard to the application will be
open to public inspection. However, information relating to a trade
secret, patent, style of work, or apparatus that, if released, would
adversely affect the organization, or any other information that would
adversely affect the national defense, will not be made available for
public inspection. Applicants must identify this information by clearly
marking it "NOT SUBJECT TO PUBLIC INSPECTION" and attach a
statement explaining why the organization asks that the information
be withheld. If the IRS agrees, the information will be withheld.
Organization's responsibilities.The organization must make
available for public inspection a copy of its approved application and
supporting documents, along with any document or letter issued by
the IRS. These must be available during regular business hours at
the organization's principal office and at each of its regional or
district offices having at least three paid employees. See Notice
88-120, 1988-2 C.B. 454. If any person under a duty to comply with
the inspection provisions fails to comply with these requirements, a
penalty of $10 a day will be imposed for each day the failure
continues.
Appeal Procedures
The organization's application will be considered by the key district
office which will either:
1. Issue a favorable determination letter;
2. Issue a proposed adverse determination letter denying the
exempt status requested; or
3. Refer the case to the National Office.
If we send you a proposed adverse determination, we will advise
you of your appeal rights at that time.
Language and Currency Requirements
Form 1023 and attachments must be prepared in English. If the
organizational document or bylaws are in any other language, an
English translation must be furnished. If the organization produces or
distributes foreign language publications that are submitted with the
application, you may be asked to provide English translations for one
or more of them during the processing of the application.
Report all financial information in U.S. dollars (specify the
conversion rate used). Combine amounts from within and outside the
United States and report the total for each item on the financial
statements.
For example:
Gross Investment Income
From U.S. sources $4,000
From non-U.S. sources 1,000
Amount to report on income statement $5,000
Annual Information Return
If the annual information return for tax-exempt organizations
becomes due while its application for recognition of exempt status is
pending with the IRS (including any appeal of a proposed adverse
determination), the organization should file Form 990, Return of
Organization Exempt From Income Tax, (or Form 990-EZ, Short
Form Return of Organization Exempt From Income Tax) and if
required, Schedule A (Form 990), Organization Exempt Under
Section 501(c)(3), or Form 990-PF, Return of Private Foundation, if a
private foundation, and indicate that an application is pending.
Special Rule for Canadian Colleges and
Universities
A Canadian college or university that has received a Form T2051,
Notification of Registration, from Revenue Canada (Department of
National Revenue, Taxation) and whose registration has not been
revoked, does not have to complete all parts of Form 1023 that
would otherwise be applicable. Such an organization must complete
only Part I of Form 1023 and Schedule B (Schools, Colleges, and
Universities). The organization must also attach a copy of its Form
T2050, Application for Registration, together with all the required
attachments that it submitted to Revenue Canada. If any
attachments were prepared in French, an English translation must be
furnished.
Other Canadian organizations seeking a determination of section
501(c)(3) status must complete Form 1023 in the same manner as
U.S. organizations.
Specific Instructions
The following instructions are keyed to the line items on the
application form:
Part I. Identification of Applicant
Line 1. Full name and address of organization.Enter the
organization's name exactly as it appears in its creating document
including amendments. If the organization will be operating under
another name, show the other name in parentheses. Enter your nine-
digit ZIP code.
If the organization's address is outside the United States or its
possessions or territories, enter the information on the line for "City
or town, state, and ZIP code" in the following order: city, province or
state, foreign postal code, and the name of the foreign country. Do
not abbreviate the country name.
Line 2. Employer identification number (EIN).All organizations
must have an EIN. Enter the nine-digit EIN assigned to the
organization by the IRS. If the organization does not have an EIN,
get Form SS-4, Application for Employer Identification Number, for
details on how to obtain an EIN immediately by telephone. If the
organization has previously applied for a number, enter "applied for"
and attach a statement giving the date of the application and the
office where it was filed. Do not apply for an EIN more than once.
Line 3. Person to contact.Enter the name and telephone number
of the person to contact during business hours if more information is
needed. The contact person should be an officer, director, or a
person with power of attorney who is familiar with the organization's
activities and is authorized to act on its behalf. Attach Form 2848 or
other power of attorney.
Line 4. Month the annual accounting period ends.Enter the
month the organization's annual accounting period ends. The
accounting period is usually the 12-month period that is the
organization's tax year. The organization's first tax year depends on
the accounting period chosen. (The first tax year could be less than
12 months).
Line 5. Date formed.Enter the date the organization became a
legal entity. For a corporation, this is the date that the articles of
incorporation were approved by the appropriate state official. For an
unincorporated organization, it is the date its constitution or articles
of association were adopted.
Page 2
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Line 6. Activity codes.Select up to three of the code numbers
listed on the back cover that best describe or most accurately
identify the organization's purposes, activities, or type of
organization. Enter the codes in the order of importance.
Line 7.Indicate if the organization is one of the following:
501 (e) Cooperative hospital service organization;
501 (f) Cooperative service organization of operating
educational organization;
501 (k) Organization providing child care.
If none of the above applies, make no entry on line 7.
Line 8.Indicate if the organization has ever filed a Form 1023 or
Form 1024, Application for Recognition of Exemption Under Section
501 (a), with the IRS.
Line 9.If the organization for which this application is being filed is
a private foundation, answer "N/A." If the organization is not required
to file Form 990 (or Form 990-EZ) and is not a private foundation,
answer "No" and attach an explanation. Get the Form 990
Instructions and refer to page 2 for a discussion of organizations not
required to file Form 990 (or Form 990-EZ). Otherwise, answer "Yes."
Line 10.Indicate if the organization has ever filed Federal income
tax returns as a taxable organization or filed returns as an exempt
organization (e.g., Form 990, 990-EZ, 990-PF, or 990-T, Exempt
Organization Business Income Tax Return).
Line 11. Type of organization and organizational documents.
Submit a conformed copy of the organizing instrument. If the
organization does not have an organizing instrument, it will not
qualify for exempt status. A conformed copy is one that agrees with
the original and all amendments to it. The conformed copy may be a
photocopy of the original signed and dated organizing document OR
it may be a copy of the organizing document that is not signed but
is accompanied by a written declaration signed by an authorized
individual stating that the copy is a complete and accurate copy of
the original signed and dated document.
In the case of a corporation, a copy of the articles of
incorporation, approved and dated by an appropriate state official, is
sufficient by itself. If an unsigned copy of the articles of
incorporation is submitted, it must be accompanied by the written
declaration discussed above. Signed or unsigned copies of the
articles of incorporation must be accompanied by a declaration
stating that the original copy of the articles was filed with, and
approved by, the state. The date filed must be specified.
In the case of an unincorporated association, the conformed copy
of the constitution, articles of association, or other organizing
document must indicate in the document itself, or in a written
declaration, that the organization was formed by the adoption of the
document by two or more persons.
If the organization has adopted bylaws, include a current copy.
The bylaws need not be signed if submitted as an attachment to the
application for recognition of exemption. The bylaws of an
organization alone are not an organizing instrument. They are merely
the internal rules and regulations of the organization.
In the case of a trust, a copy of the signed and dated trust
instrument must be furnished.
For your organization to qualify for exempt status, its organizing
instrument must contain a proper dissolution clause, or state law
must provide for distribution of assets for one or more exempt
(section 501(c)(3)) purposes upon dissolution. If you rely on state law,
please cite the law and briefly state its provisions on an attachment.
Foreign organizations must cite and attach a copy of the foreign
statute along with an English language translation.
See Pub. 557 for a discussion of dissolution clauses under the
heading, Dedication and Distribution of Assets. Examples of
dissolution clauses are shown in the sample organizing instruments.
The organizing instrument must also specify the organizational
purposes and the purposes specified must be limited to one or more
of those set out in section 501(c)(3). See Pub. 557 for detailed
instructions and for sample organizing instruments that satisfy the
requirements of section 501(c)(3) and the related regulations.
Part II. Activities and Operational
Information
Line 1.It is important that you report all activities carried on by the
organization to enable the IRS to make a proper determination of the
organization's exempt status.
Line 2.If it is anticipated that the organization's principal sources
of support will increase or decrease substantially in relation to the
organization's total support, attach a statement describing
anticipated changes and explaining the basis for the expectation.
Line 3.For purposes of providing the information requested on line
3, "fundraising activity" includes the solicitation of contributions and
both functionally related activities and unrelated business activities.
Include a description of the nature and magnitude of the activities.
Line 4a.Furnish the mailing addresses of the organization's
principal officers, directors, or trustees. Do not give the address of
the organization.
Line 4b.The annual compensation includes salary, bonus, and any
other form of payment to the individual for services while employed
by the organization.
Line 4c.Public officials include anyone holding an elected position
or anyone appointed to a position by an elected official.
Line 4d.For purposes of this application, a "disqualified person" is
any person who, if the applicant organization were a private
foundation, is:
1. A "substantial contributor" to the foundation (defined below);
2. A foundation manager;
3. An owner of more than 20% of the total combined voting
power of a corporation that is a substantial contributor to the
foundation;
4. A "member of the family" of any person described in 1, 2, or 3
above;
5. A corporation, partnership, or trust in which persons described
in 1, 2, 3, or 4 above, hold more than 35% of the combined voting
power, the profits interest, or the beneficial interests; and
6. Any other private foundation that is effectively controlled by the
same persons who control the first-mentioned private foundation or
any other private foundation substantially all of whose contributions
were made by the same contributors.
A substantial contributor is any person who gave a total of more
than $5,000 to the organization, and those contributions are more
than 2% of all the contributions and bequests received by the
organization from the date it was created up to the end of the year
the contributions by the substantial contributor were received. A
creator of a trust is treated as a substantial contributor regardless of
the amount contributed by that person or others.
See Pub. 578 for more information on "disqualified persons."
Line 5.If your organization controls or is controlled by another
exempt organization or a taxable organization, answer "Yes."
"Control" means that:
1. Fifty percent (50%) or more of the filing organization's officers,
directors, trustees, or key employees are also officers, directors,
trustees, or key employees of the second organization being tested
for control;
2. The filing organization appoints 50% or more of the officers,
directors, trustees, or key employees of the second organization; or
3. Fifty percent (50%) or more of the filing organization's officers,
directors, trustees, or key employees are appointed by the second
organization.
Control exists if the 50% test is met by any one group of persons
even if collectively the 50% test is not met. Examples of special
relationships are common officers and the sharing of office space or
employees.
Line 6.If the organization conducts any financial transactions
(either receiving funds or paying out funds), or nonfinancial activities
with an exempt organization (other than a 501(c)(3) organization), or
with a political organization, answer "Yes," and explain.
Line 7.If the organization must report its income and expense
activity to any other organization (tax-exempt or taxable entity),
answer "Yes."
Line 8.Examples of assets used to perform an exempt function
are: land, building, equipment, and publications. Do not include cash
or property producing investment income. If you have no assets
used in performing the organization's exempt function, answer
"N/A."
Line 10a.If the organization is managed by another exempt
organization, a taxable organization, or an individual, answer "Yes."
Page 3
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Line 10b.If the organization leases property from anyone or leases
any of its property to anyone, answer "Yes."
Line 11.A membership organization for purposes of this question
is an organization that is composed of individuals or organizations
who:
1. Share in the common goal for which the organization was
created;
2. Actively participate in achieving the organization's purposes;
and
3. Pay dues.
Line 12.Examples of benefits, services, and products are: meals to
homeless people, home for the aged, museum open to the public,
and a symphony orchestra giving public performances.
Note: Organizations that provide low-income housing should see
Rev. Proc. 96-32, 1996-20 I.R.B. 14, for a "safe harbor" and an
alternative facts and circumstances test to be used in completing line
12.
Line 13.An organization is attempting to influence legislation if it
contacts or urges the public to contact members of a legislative
body, for the purpose of proposing, supporting, or opposing
legislation, or if it advocates the adoption or rejection of legislation.
If you answer "Yes," you may want to file Form 5768,
Election/Revocation of Election by an Eligible Section 501 (c)(3)
Organization To Make Expenditures To Influence Legislation.
Line 14.An organization is intervening in a political campaign if it
promotes or opposes the candidacy or prospective candidacy of an
individual for public office.
Part III. Technical Requirements
Line 1.If you check "Yes," proceed to line 8. If you check "No,"
proceed to line 2.
Line 2a.To qualify as an integrated auxiliary, an organization must
not be a private foundation and must satisfy the affiliation and
support tests of Regulations section 1.6033-2(h).
Line 3.Relief from the 15-month filing requirement is granted
automatically if the organization submits a completed Form 1023
within 12 months from the end of the 15-month period.
Line 4.See Rev. Proc. 92-85, 1992-2 C.B. 490, for information
about an extension beyond the 27-month period. According to
section 5.01 of Rev. Proc. 92-85, the IRS will allow an organization
an extension of time to file a Form 1023 application under a
reasonable action and good-faith standard. In such case, the
organization does not need to provide any further information or
affidavits provided that it files its application before the IRS has
discovered the organization's failure to file an application.
Line 5.The reasons for late filing should be specific to your
particular organization and situation. Rev. Proc. 92-85 lists the
factors the IRS will consider in determining if good cause exists for
granting an extension of time to file the application. (Also see Pub.
557.) To address these factors, your response on line 5 should
provide the following information:
1. Whether the organization consulted an attorney or accountant
knowledgeable in tax matters or communicated with a responsible
IRS employee (before or after the organization was created) to
ascertain the organization's Federal filing requirements and, if so, the
names and occupations or titles of the persons contacted, the
approximate dates, and the substance of the information obtained;
2. How and when the organization learned about the 15-month
deadline for filing Form 1023;
3. Whether any significant intervening circumstances beyond the
organization's control prevented it from submitting the application
timely or within a reasonable period of time after it learned of the
requirement to file the application within the 15-month period; and
4. Any other information that you believe may establish good
cause for not filing timely or otherwise justify granting the relief
sought.
Line 7.The organization may still be able to qualify for exemption
under section 501(c)(4) for the period preceding the effective date of
its exemption as a section 501(c)(3) organization. If the organization
is qualified under section 501(c)(4) and page 1 of Form 1024 is filed
as directed, the organization will not be liable for income tax returns
as a taxable entity. Contributions to section 501(c)(4) organizations
are generally not deductible by donors as charitable contributions.
Line 8.Private foundations are subject to various requirements,
restrictions, and excise taxes under Chapter 42 of the Code that do
not apply to public charities. Also, contributions to private
foundations may receive less favorable treatment than contributions
to public charities. See Pub. 578. Therefore, it is usually to an
organization's advantage to show that it qualifies as a public charity
rather than as a private foundation if its activities or sources of
support permit it to do so. Unless an organization meets one of the
exceptions below, it is a private foundation. In general, an
organization is not a private foundation if it is:
1. A church, school, hospital, or governmental unit;
2. A medical research organization operated in conjunction with a
hospital;
3. An organization operated for the benefit of a college or
university that is owned or operated by a governmental unit;
4. An organization that normally receives a substantial part of its
support in the form of contributions from a governmental unit or from
the general public as provided in section 170(b)(1)(A)(vi);
5. An organization that normally receives not more than one-third
of its support from gross investment income and more than
one-third of its support from contributions, membership fees, and
gross receipts related to its exempt functions (subject to certain
exceptions) as provided in section 509(a)(2);
6. An organization operated solely for the benefit of, and in
connection with, one or more organizations described above (or for
the benefit of one or more of the organizations described in section
501 (c)(4), (5), or (6) of the Code and also described in 5 above), but
not controlled by disqualified persons other than foundation
managers, as provided in section 509(a)(3); or
7. An organization organized and operated to test for public safety
as provided in section 509(a)(4).
Line 9.Basis for private operating foundation status: (Complete
this line only if you answered "Yes" to the question on line 8.)
A "private operating foundation" is a private foundation that
spends substantially all of its adjusted net income or its minimum
investment return, whichever is less, directly for the active conduct
of the activities constituting the purpose or function for which it is
organized and operated. The foundation must satisfy the income test
and one of the three supplemental tests: (1) the assets test; (2) the
endowment test; or (3) the support test. For additional information,
see Pub. 578.
Line 10.Basis for nonprivate foundation status: Check the box that
shows why your organization is not a private foundation.
Box (a). A church or convention or association of churches.
Box (b). A school.See the definition in the instructions for
Schedule B.
Box (c). A hospital or medical research organization.See the
instructions for Schedule C.
Box (d). A governmental unit. This category includes a state, a
possession of the United States, or a political subdivision of any of
the foregoing, or the United States, or the District of Columbia.
Box (e). Organizations operated in connection with or solely for
organizations described in (a) through (d) or (g), (h), and (/). The
organization must be organized and operated for the benefit of, to
perform the functions of, or to carry out the purposes of one or more
specified organizations described in section 509(a)(1) or (2). It must
be operated, supervised, or controlled by or in connection with one
or more of the organizations described in the instructions for boxes
(a) through (d) or (g), (h), and (i). It must not be controlled directly or
indirectly by disqualified persons (other than foundation managers or
organizations described in section 509(a)(1) or (2)). To show whether
the organization satisfies these tests, complete Schedule D.
Box (f). An organization testing for public safety.An organization
in this category is one that tests products to determine their
acceptability for use by the general public. It does not include any
organization testing for the benefit of a manufacturer as an operation
or control in the manufacture of its product.
Box (g). Organization for the benefit of a college or university
owned or operated by a governmental unitThe organization must
be organized and operated exclusively for the benefit of a college or
university that is an educational organization within the meaning of
section 170(b)(1)(A)(ii) and is an agency or instrumentality of a state
or political subdivision of a state; is owned or operated by a state or
political subdivision of a state; or is owned or operated by an agency
or instrumentality of one or more states or political subdivisions. The
organization must also normally receive a substantial part of its
support from the United States or any state or political subdivision of
a state, or from direct or indirect contributions from the general
Page 4
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public or from a combination of these sources. An organizaton
described in section 170(b)(1)(A)(iv) will be subject to the same
publicly supported rules that are applicable to 170(b)(1)(A)(vi)
organizations described in box (h) below.
Box (h). Organization receiving support from a governmental unit
or from the general public.The organization must receive a
substantial part of its support from the United States or any state or
political subdivision, or from direct or indirect contributions from the
general public, or from a combination of these sources. The
organization may satisfy the support requirement in either of two
ways. It will be treated as publicly supported if the support it
normally receives from the above-described governmental units and
the general public equals at least one-third of its total support. It will
also be treated as publicly supported if the support it normally
receives from governmental or public sources equals at least 10% of
total support and the organization is set up to attract new and
additional public or governmental support on a continuous basis. If
the organization's governmental and public support is at least 10%,
but not over one-third of its total support, the questions on lines 1
through 14 of Part II will apply to determine both the organization's
claim of exemption and whether it is publicly supported. Preparers
should exercise care to assure that those questions are answered in
detail.
Box (i). Organization described in section 509(a)(2).The
organization must satisfy the support test under section 509(a)(2)(A)
and the gross investment income test under section 509(a)(2)(B). To
satisfy the support test, the organization must normally receive more
than one-third of its support from: (a) gifts, grants, contributions, or
membership fees, and (b) gross receipts from admissions, sales of
merchandise, performance of services, or furnishing of facilities, in
an activity that is not an unrelated trade or business (subject to
certain limitations discussed below). This one-third of support must
be from organizations described in section 509(a)(1), governmental
sources, or persons other than disqualified persons. In computing
gross receipts from admissions, sales of merchandise, performance
of services, or furnishing of facilities in an activity that is not an
unrelated trade or business, the gross receipts from any one person
or from any bureau or similar agency of a governmental unit are
includible only to the extent they do not exceed the greater of
$5,000 or 1% of the organization's total support. To satisfy the gross
investment income test, the organization must not receive more than
one-third of its support from gross investment income.
Box (j).If you believe the organization meets the public support
test of section 170(b)(1)(A)(vi) or 509(a)(2) but are uncertain as to
which public support test it satisfies, check box (j). By checking this
box, you are claiming that the organization is not a private
foundation and are agreeing to let the IRS compute the public
support of your organization and determine the correct foundation
status.
Line 11.To receive a definitive (final) ruling under sections
170(b)(1)(A)(vi) and 509(a)(1) or under section 509(a)(2), an
organization must have completed a tax year consisting of at least 8
months. Organizations that checked box (h), (i), or (j) on line 10 that
do not satisfy the 8-month requirement must request an advance
ruling covering their first 5 tax years instead of a definitive ruling.
An organization that satisfies the 8-month requirement has two
options:
1. It may request a definitive ruling. In this event, the
organization's qualification under sections 170(b)(1)(A)(vi) and
509(a)(1) or under section 509(a)(2) will be based on the support that
the organization has received to date; or
2. It may request an advance ruling. If the IRS issues the advance
ruling, the organization's public support computation will be based
on the support it receives during its first 5 tax years. An organization
should consider this option if it has not received significant public
support during its first tax year or during its first and second tax
years, but it reasonably expects to receive such support by the end
of its fifth tax year. An organization that receives an advance ruling is
treated, during the 5-year advance ruling period, as a public charity
(rather than a private foundation) for certain purposes, including
those relating to the deductibility of contributions by the general
public.
Line 12.For definition of an unusual grant, see instructions for Part
IV-A, line 12.
Line 13.Answer this question only if you checked box (g), (h), or (j)
on line 10.
Page 5
Line 14.Answer the question on this line only if you checked box
(i) or (j) on line 10 and are requesting a definitive ruling on line 11.
Line 15.Answer "Yes" or "No" on each line. If "Yes," you must
complete the appropriate schedule. Each schedule is included in this
application package with accompanying instructions. For a brief
definition of each type of organization, see the appropriate schedule.
Part IV. Financial Data
The Statement of Revenue and Expenses must be completed for
the current year and each of the 3 years immediately before it (or
the years the organization has existed, if less than 4). Any applicant
that has existed for less than 7 year must give financial data for the
current year and proposed budgets for the following 2 years. We
may request financial data for more than 4 years if necessary. All
financial information for the current year must cover the period
beginning on the first day of the organization's established annual
accounting period and ending on any day that is within 60 days of
the date of this application. If the date of this application is less than
60 days after the first day of the current accounting period, no
financial information is required for the current year. Financial
information is required for the 3 preceding years regardless of the
current year requirements. Please note that if no financial information
is required for the current year, the preceding year's financial
information can end on any day that is within 60 days of the date of
this application. Prepare the statements using the method of
accounting and the accounting period (entered on line 4 of Part I)
the organization uses in keeping its books and records. If the
organization uses a method other than the cash receipts and
disbursements method, attach a statement explaining the method
used.
A. Statement of Revenue and Expenses
Line 1.Do not include amounts received from the general public or
a governmental unit for the exercise or performance of the
organization's exempt functions. However, payments made by a
governmental unit to enable the organization to provide a service to
the general public should be included. Also, do not include unusual
grants. For an explanation of unusual grants, see the discussion for
Line 12 on the following page.
Line 2.Include amounts received from members for the basic
purpose of providing support to the organization. These are
considered to be contributions. Do not include payments to
purchase admissions, merchandise, services, or use of facilities.
Line 3.Include on this line the income received from dividends,
interest, and payments received on securities loans, rents, and
royalties.
Line 4.Enter the organization's net income from any activities that
are regularly carried on and are not related to the organization's
exempt purposes. Examples of such income include fees from the
commercial testing of products; income from renting office
equipment or other personal property; and income from the sale of
advertising in an exempt organization's periodical. See Pub. 598 for
information about unrelated business income and activities.
Line 5.Enter the amount collected by the local tax authority from
the general public that has been allocated for your organization.
Line 6.To report the value of services and/or facilities furnished by
a governmental unit, use the fair market value at the time the
service/facility was furnished to your organization. Do not include
any other donated services or facilities in Part IV.
Line 7.Enter the total income from all sources that is not reported
on lines 1 through 6, or lines 9, 11, and 12. Attach a schedule that
lists each type of revenue source and the amount derived from each.
Line 9.Include income generated by the organization's exempt
function activities (charitable, educational, etc.) and by its nontaxable
fundraising events (excluding any contributions received). Examples
of such income include the income derived by a symphony orchestra
from the sale of tickets to its performances; and raffles, bingo, or
other fundraising-event income that is not taxable as unrelated
business income because the income-producing activities are not
regularly carried on or because they are conducted with substantially
all (at least 85%) volunteer labor. Record related cost of sales on line
22, Other.
Line 11.Attach a schedule that shows a description of each asset,
the name of the person to whom sold, and the amount received. In
the case of publicly traded securities sold through a broker, the
name of the purchaser is not required.
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Line 12.Unusual grants generally consist of substantial
contributions and bequests from disinterested persons that:
1. Are attracted by reason of the publicly supported nature of the
organization;
2. Are unusual and unexpected as to the amount; and
3. Would, by reason of their size, adversely affect the status of the
organization as normally meeting the support test of section
170(b)(1)(A)(vi) or section 509(a)(2), as the case may be.
If the organization is awarded an unusual grant and the terms of
the granting instrument provide that the organization will receive the
funds over a period of years, the amount received by the
organization each year under the grant may be excluded. See the
regulations under sections 170 and 509.
Line 14.Fundraising expenses represent the total expenses
incurred in soliciting contributions, gifts, grants, etc.
Line 15.Attach a schedule showing the name of the recipient, a
brief description of the purposes or conditions of payment, and the
amount paid. The following example shows the format and amount
of detail required for this schedule:
Line 4.Attach a schedule that shows the name of the borrower, a
brief description of the obligation, the rate of return on the principal
indebtedness, the due date, and the amount due. The following
example shows the format and amount of detail required:
Recipient
Museum of Natural History
State University
Richard Roe
Purpose
General operating budget
Books for needy students
Educational scholarship
Amount
$9,000
4,500
2,200
Colleges, universities, and other educational institutions and
agencies subject to the Family Educational Rights and Privacy Act
(20 U.S.C. 1232g) are not required to list the names of individuals
who were provided scholarships or other financial assistance where
such disclosure would violate the privacy provisions of the law.
Instead, such organizations should group each type of financial aid
provided, indicate the number of individuals who received the aid,
and specify the aggregate dollar amount.
Line 16.Attach a schedule showing the name of each recipient, a
brief description of the purposes or condition of payment, and
amount paid. Do not include any amounts that are on line 15. The
schedule should be similar to the schedule shown in the line 15
instructions above.
Line 17.Attach a schedule that shows the name of the person
compensated; the office or position; the average amount of time
devoted to the organization's affairs per week, month, etc.; and the
amount of annual compensation. The following example shows the
format and amount of detail required:
Name
Philip Poe
Position
President and
general manager
Time devoted
16 hrs. per wk.
Annual salary
$7,500
Line 18.Enter the total of employees' salaries not reported on line
17.
Line 19.Enter the total interest expense for the year, excluding
mortgage interest treated as occupancy expense on line 20.
Line 20.Enter the amount paid for the use of office space or other
facilities, heat, light, power, and other utilities, outside janitorial
services, mortgage interest, real estate taxes, and similar expenses.
Line 21.If your organization records depreciation, depletion, and
similar expenses, enter the total.
Line 22.Attach a schedule listing the type and amount of each
significant expense for which a separate line is not provided. Report
other miscellaneous expenses as a single total if not substantial in
amount.
B. Balance Sheet
Line 1.Enter the total cash in checking and savings accounts,
temporary cash investments (money market funds, CDs, treasury
bills, or other obligations that mature in less than 1 year), change
funds, and petty cash funds.
Line 2.Enter the total accounts receivable that arose from the sale
of goods and/or performance of services, less any reserve for bad
debt.
Line 3.Enter the amount of materials, goods, and supplies
purchased or manufactured by the organization and held to be sold
or used in some future period.
Name of
borrower
Hope Soap
Corporation
Big Spool
Company
Description of obligation
Debenture bond (no senior
issue outstanding)
Collateral note secured by
company's fleet of 20
delivery trucks
Rate of
return
10%
12%
Due date
Jan. 2004
Jan. 2003
Amount
$ 7,500
62,000
Line 5.Attach a schedule listing the organization's corporate stock
holdings. For stock of closely held corporations, the statement
should show the name of the corporation, a brief summary of the
corporation's capital structure, and the number of shares held and
their value as carried on the organization's books. If such valuation
does not reflect current fair market value, also include fair market
value. For stock traded on an organized exchange or in substantial
quantities over the counter, the statement should show the name of
the corporation, a description of the stock and the principal
exchange on which it is traded, the number of shares held, and their
value as carried on the organization's books. The following example
shows the format and the amount of detail required:
Name of
corporation
Little Spool
Corporation
Flintlock
Corporation
Capital structure (or
exchange on which traded)
100 shares nonvoting
preferred issued and
outstanding, no par
value; 50 shares
common issued and
outstanding, no par
value.
Preferred shares:
Common shares:
Class A common
N.Y.S.E.
Shares
50
10
20
Book
amount
$20,000
25,000
3,000
Fair
market
value
$24,000
30,000
3,500
Line 6.Report each loan separately, even if more than one loan
was made to the same person. Attach a schedule that shows the
borrower's name, purpose of loan, repayment terms, interest rate,
and original amount of loan.
Line 7.Enter the book value of government securities held (U.S.,
state, or municipal). Also enter the book value of buildings and
equipment held for investment purposes. Attach a schedule
identifying and reporting the book value of each.
Line 8.Enter the book value of buildings and equipment not held
for investment. This includes plant and equipment used by the
organization in conducting its exempt activities. Attach a schedule
listing these assets held at the end of the current tax year/period
and the cost or other basis.
Line 9.Enter the book value of land not held for investment.
Line 10.Enter the book value of each category of assets not
reported on lines 1 through 9. Attach a schedule listing each.
Line 12.Enter the total of accounts payable to suppliers and
others, such as salaries payable, accrued payroll taxes, and interest
payable.
Line 13.Enter the unpaid portion of grants and contributions that
the organization has made a commitment to pay other organizations
or individuals.
Line 14.Enter the total of mortgages and other notes payable
outstanding at the end of the current tax year/period. Attach a
schedule that shows each item separately and the lender's name,
purpose of loan, repayment terms, interest rate, and original amount.
Line 15.Enter the amount of each liability not reported on lines 12
through 14. Attach a separate schedule.
Line 17.Under fund accounting, an organization segregates its
assets, liabilities, and net assets into separate funds according to
restrictions on the use of certain assets. Each fund is like a separate
entity in that it has a self-balancing set of accounts showing assets,
liabilities, equity (fund balance), income, and expenses. If the
organization does not use fund accounting, report only the "net
assets" account balances, such as: capital stock, paid-in capital,
and retained earnings or accumulated income.
y Page 6
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Procedural Checklist
Make sure the application is complete.
If you do not complete all applicable parts or do not provide all required attachments,
we may return the incomplete application to your organization for resubmission with the
missing information or attachments. This will delay the processing of the application and
may delay the effective date of your organization's exempt status. The organization may
also incur additional user fees.
Have you . . .
Attached Form 8718 (User Fee for Exempt Organization Determination Letter Request)
and the appropriate fee?
Located the correct IRS key district office for the mailing of the application? (See
Where To File addresses on Form 8718.) Do not file the application with your local
Internal Revenue Service Center.
Completed Parts I through IV and any other schedules that apply to the organization?
Shown the organization's Employer Identification Number (EIIM)?
a. If your organization has an BIN, write it in the space provided.
b. If this is a newly formed organization and does not have an Employer Identification
Number, obtain an EIN by telephone. (See Specific Instructions, Part I, Line 2, on page 2.)
Described your organization's specific activities as directed in Part II, line 1, of the
application?
Included a conformed copy of the complete organizing instrument? (See Specific
Instructions, Part I, Line 11, on page 3.)
Had the application signed by one of the following?
a. An officer or trustee who is authorized to sign (e.g., president, treasurer); or
b. A person authorized by a power of attorney (Submit Form 2848, or other power of
attorney)
Enclosed financial statements (Part IV)?
a. Current year (must include period up to within 60 days of the date the application is
filed) and 3 preceding years.
b. Detailed breakdown of revenue and expenses (no lump sums).
c. If the organization has been in existence less than 1 year, you must also submit
proposed budgets for 2 years showing the amounts and types of receipts and
expenditures anticipated.
Note: During the technical review of a completed application by the Employee
Plans/Exempt Organizations Division in the key district or by Exempt Organizations
Division in the National Office, it may be necessary to contact the organization for more
specific or additional information.
Do not send this checklist with the application.
Page 7
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Form 1 U^U
(Rev. April 1996)
Department of the Treasury
Internal Revenue Service
Application for Recognition of Exemption
Under Section 501(c)(3) of the Internal Revenue Code
OMB No. 1545-0056
If exempt status is
approved, this
application will be open
for public inspection.
Read the instructions for each Part carefully.
A User Fee must be attached to this application.
If the required information and appropriate documents are not submitted along with Form 8718 (with payment of the
appropriate user fee), the application may be returned to you.
Complete the Procedural Checklist on page 7 of the instructions.
Identification of Applicant
1a
1b
1c
1d
5
Full name of organization (as shown in organizing document)
c/o Name (if applicable)
Address (number and street) Room/Suite
City or town, state, and ZIP code
Date incorporated or formed 6 Activity codes (See page 3 of the instructions.)
2 Employer identification number (FIN)
(If none, see page 2 of the instructions.)
3 Name and telephone number of person
to be contacted if additional information
is needed
( )
4 Month the annual accounting period ends
7 Check here if applying under section:
a D501(e) bD501(f) cD501(k)
8 Did the organization previously apply for recognition of exemption under this Code section or under any
other section of the Code? D Yes D No
If "Yes," attach an explanation.
9 Is the organization required to file Form 990 (or Form 990-EZ)? . . .
If "No," attach an explanation (see page 3 of the Specific Instructions).
D N/A D Yes D No
10 Has the organization filed Federal income tax returns or exempt organization information returns?
If "Yes," state the form numbers, years filed, and Internal Revenue office where filed.
D Yes D No
11 Check the box for the type of organization. ATTACH A CONFORMED COPY OF THE CORRESPONDING ORGANIZING
DOCUMENTS TO THE APPLICATION BEFORE MAILING. (See Specific Instructions for Part I, Line 11, on page 3.) Get
Pub. 557, Tax-Exempt Status for Your Organization, for examples of organizational documents.)
a D CorporationAttach a copy of the Articles of Incorporation (including amendments and restatements) showing
approval by the appropriate state official; also include a copy of the bylaws.
b D Trust Attach a copy of the Trust Indenture or Agreement, including all appropriate signatures and dates.
c D AssociationAttach a copy of the Articles of Association, Constitution, or other creating document, with a
declaration (see instructions) or other evidence the organization was formed by adoption of the
document by more than one person; also include a copy of the bylaws.
If the organization is a corporation or an unincorporated association that has not yet adopted bylaws, check here ^ fj
I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization and that I have examined this application,
including the accompanying schedules and attachments, and to the best of my knowledge it is true, correct, and complete.
Please
Sign L
Here y (Signature)
(Title or authority of signer)
(Date)
For Paperwork Reduction Act Notice, see page 1 of the instructions.
Cat. No. 17133K
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Form 1023 (Rev. 4-96) Page 2
Activities and Operational Information
Provide a detailed narrative description of all the activities of the organizationpast, present, and planned. Do not merely
refer to or repeat the language in the organizational document. List each activity separately in the order of importance
based on the relative time and other resources devoted to the activity. Indicate the percentage of time for each activity.
Each description should include, as a minimum, the following: (a) a detailed description of the activity including its purpose
and how each acitivity furthers your exempt purpose; (b) when the activity was or will be initiated; and (c) where and by
whom the activity will be conducted.
2 What are or will be the organization's sources of financial support? List in order of size.
3 Describe the organization's fundraising program, both actual and planned, and explain to what extent it has been put into
effect. Include details of fundraising activities such as selective mailings, formation of fundraising committees, use of
volunteers or professional fundraisers, etc. Attach representative copies of solicitations for financial support.
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Form 1023 (Rev. 4-96)
Page 3
Activities and Operational Information (Continued)
4 Give the following information about the organization's governing body:
a Names, addresses, and titles of officers, directors, trustees, etc.
b Annual compensation
c Do any of the above persons serve as members of the governing body by reason of being public officials
or being appointed by public officials? D Yes D No
If "Yes," name those persons and explain the basis of their selection or appointment.
Are any members of the organization's governing body "disqualified persons" with respect to the
organization (other than by reason of being a member of the governing body) or do any of the members
have either a business or family relationship with "disqualified persons"? (See Specific Instructions for
Part II, Line 4d, on page 3.) D Yes D No
If "Yes," explain.
5 Does the organization control or is it controlled by any other organization? D Yes D No
Is the organization the outgrowth of (or successor to) another organization, or does it have a special
relationship with another organization by reason of interlocking directorates or other factors? . . . . d Yes D No
If either of these questions is answered "Yes," explain.
6 Does or will the organization directly or indirectly engage in any of the following transactions with any
political organization or other exempt organization (other than a 501(c)(3) organization): (a) grants;
(b) purchases or sales of assets; (c) rental of facilities or equipment; (d) loans or loan guarantees;
(e) reimbursement arrangements; (f) performance of services, membership, or fundraising solicitations;
or (g) sharing of facilities, equipment, mailing lists or other assets, or paid employees? D Yes D No
If "Yes," explain fully and identify the other organizations involved.
7 Is the organization financially accountable to any other organization? D Yes D No
If "Yes," explain and identify the other organization. Include details concerning accountability or attach
copies of reports if any have been submitted.
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Form 1023 (Rev. 4-96) Page 4
I^^JH Activities and Operational Information (Continued)
8 What assets does the organization have that are used in the performance of its exempt function? (Do not include property
producing investment income.) If any assets are not fully operational, explain their status, what additional steps remain to
be completed, and when such final steps will be taken. If "None," indicate "N/A."
9 Will the organization be the beneficiary of tax-exempt bond financing within the next 2 years?. . . . D Yes D No
10a Will any of the organization's facilities or operations be managed by another organization or individual
under a contractual agreement? O Yes D No
b Is the organization a party to any leases? D Yes D No
If either of these questions is answered "Yes," attach a copy of the contracts and explain the relationship
between the applicant and the other parties.
11 Is the organization a membership organization? D Yes D No
If "Yes," complete the following:
a Describe the organization's membership requirements and attach a schedule of membership fees and
dues.
b Describe the organization's present and proposed efforts to attract members and attach a copy of any
descriptive literature or promotional material used for this purpose.
c What benefits do (or will) the members receive in exchange for their payment of dues?
12a If the organization provides benefits, services, or products, are the recipients required, or will
they be required, to pay for them? D N/A D Yes D No
If "Yes," explain how the charges are determined and attach a copy of the current fee schedule.
b Does or will the organization limit its benefits, services, or products to specific individuals or
classes of individuals? D N/A D Yes D No
If "Yes," explain how the recipients or beneficiaries are or will be selected.
13 Does or will the organization attempt to influence legislation? D Yes D No
If "Yes," explain. Also, give an estimate of the percentage of the organization's time and funds that it
devotes or plans to devote to this activity.
14 Does or will the organization intervene in any way in political campaigns, including the publication or
distribution of statements? Q Yes D No
If "Yes," explain fully.
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Form 1023 (Rev. 4-96) Page 5
Technical Requirements
1 Are you filing Form 1023 within 15 months from the end of the month in which your organization was
created or formed? D Yes D No
If you answer "Yes," do not answer questions on lines 2 through 7 below.
2 If one of the exceptions to the 15-month filing requirement shown below applies, check the appropriate box and proceed
to question 8.
ExceptionsYou are not required to file an exemption application within 15 months if the organization:
D a Is a church, interchurch organization of local units of a church, a convention or association of churches, or an
integrated auxiliary of a church. See Specific Instructions, Line 2a, on page 4;
D b Is not a private foundation and normally has gross receipts of not more than $5,000 in each tax year; or
D c Is a subordinate organization covered by a group exemption letter, but only if the parent or supervisory organization
timely submitted a notice covering the subordinate.
3 If the organization does not meet any of the exceptions on line 2 above, are you filing Form 1023 within
27 months from the end of the month in which the organization was created or formed? D Yes D No
If "Yes," your organization qualifies under section 4.01 of Rev. Proc. 92-85, 1992-2 C.B. 490, for an
automatic 12-month extension of the 15-month filing requirement. Do not answer questions 4 through 7.
If "No," answer question 4.
4 If you answer "No" to question 3, has the organization been contacted by the IRS regarding its failure to
file Form 1023 within 27 months from the end of the month in which the organization was created or
formed? D Yes D No
If "No," your organization is requesting an extension of time to apply under the "reasonable action and
good faith" requirements of section 5.01 of Rev. Proc. 92-85. Do not answer questions 5 through 7.
If "Yes," answer question 5.
5 If you answer "Yes" to question 4, does the organization wish to request relief from the 15-month filing
requirement? D Yes D No
If "Yes," give the reasons for not filing this application prior to being contacted by the IRS. See Specific
Instructions, Line 5, on page 4 before completing this item. Do not answer questions 6 and 7.
If "No," answer question 6.
6 If you answer "No" to question 5, your organization's qualification as a section 501(c)(3) organization can
be recognized only from the date this application is filed with your key District Director. Therefore, do you
want us to consider the application as a request for recognition of exemption as a section 501(c)(3)
organization from the date the application is received and not retroactively to the date the organization
was created or formed? d Yes D No
7 If you answer "Yes" to question 6 above and wish to request recognition of section 501(c)(4) status for the period beginning
with the date the organization was formed and ending with the date the Form 1023 application was received (the effective
date of the organization's section 501(c)(3) status), check here > D and attach a completed page 1 of Form 1024 to this
application.
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Form 1023 (Rev. 4-96)
Page 6
Technical Requirements (Continued)
8 Is the organization a private foundation?
D Yes (Answer question 9.)
D No (Answer question 10 and proceed as instructed.]
9 If you answer "Yes" to question 8, does the organization claim to be a private operating foundation?
D Yes (Complete Schedule E.)
D No
After answering question 9 on this line, go to line 15 on page 7.
10 If you answer "No" to question 8, indicate the public charity classification the organization is requesting by checking the
box below that most appropriately applies:
THE ORGANIZATION IS NOT A PRIVATE FOUNDATION BECAUSE IT QUALIFIES:
a
b
c
d
e
f
9
h
D
D
D
D
D
D
D
D
D
As a church or a convention or association of churches
(CHURCHES MUST COMPLETE SCHEDULE A.)
As a school (MUST COMPLETE SCHEDULE B.)
As a hospital or a cooperative hospital service organization, or a
medical research organization operated in conjunction with a
hospital (MUST COMPLETE SCHEDULE C.)
As a governmental unit described in section 170(c)(1).
As being operated solely for the benefit of, or in connection with,
one or more of the organizations described in a through d, g, h, or i
(MUST COMPLETE SCHEDULE D.)
As being organized and operated exclusively for testing for public
safety.
As being operated for the benefit of a college or university that is
owned or operated by a governmental unit.
As receiving a substantial part of its support in the form of
contributions from publicly supported organizations, from a
governmental unit, or from the general public.
As normally receiving not more than one-third of its support from
gross investment income and more than one-third of its support from
contributions, membership fees, and gross receipts from activities
related to its exempt functions (subject to certain exceptions).
Sections 509(a)(1)
and 170(b)(1)(A)(i)
Sections 509(a)(1)
and 170(b)(1)(A)(ii)
Sections 509(a)(1)
and 170(b)(1)(A)(iii)
Sections 509(a)(1)
and 170(b)(1)(A)(v)
Section 509(a)(3)
Section 509(a)(4)
Sections 509(a)(1)
and 170(b)(1)(A)(iv)
Sections 509(a)(1)
and 170(b)(1)(A)(vi)
Section 509(a)(2)
The organization is a publicly supported organization but is not sure
whether it meets the public support test of block h or block i. The
organization would like the IRS to decide the proper classification.
Sections 509(a)(1)
and 170(b)(1)(A)(vi)
or Section 509(a)(2)
If you checked one of the boxes a through f in question 10, go to question
15. If you checked box g in question 10, go to questions 12 and 13.
If you checked box h, i, or j, in question 10, go to question 11.
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Form 1023 (Rev. 4-96)
Page 7
Technical Requirements (Continued)
11 If you checked box h, i, or j in question 10, has the organization completed a tax year of at least 8 months?
CH YesIndicate whether you are requesting:
CH A definitive ruling (Answer questions 12 through 15.)
D An advance ruling (Answer questions 12 and 15 and attach two Forms 872-C completed and signed.)
EH NoYou must request an advance ruling by completing and signing two Forms 872-C and attaching them to the
application.
12 If the organization received any unusual grants during any of the tax years shown in Part IV-A, attach a list for each year
showing the name of the contributor; the date and the amount of the grant; and a brief description of the nature of the grant.
13 If you are requesting a definitive ruling under section 170(b)(1)(A)(iv) or (vi), check here ^- D and:
a Enter 2% of line 8, column (e), Total, of Part IV-A. _
b Attach a list showing the name and amount contributed by each person (other than a governmental unit or "publicly
supported" organization) whose total gifts, grants, contributions, etc., were more than the amount entered on line 13a
above.
14 If you are requesting a definitive ruling under section 509(a)(2), check here ^- D and:
a For each of the years included on lines 1, 2, and 9 of Part IV-A, attach a list showing the name of and amount received
from each "disqualified person." (For a definition of "disqualified person," see Specific Instructions, Part II, Line 4d, on
page 3.)
b For each of the years included on line 9 of Part IV-A, attach a list showing the name of and amount received from each
payer (other than a "disqualified person") whose payments to the organization were more than $5,000. For this purpose,
"payer" includes, but is not limited to, any organization described in sections 170(b)(1)(A)(i) through (vi) and any
governmental agency or bureau.
15 Indicate if your organization is one of the following. If so, complete the required schedule. (Submit
only those schedules that apply to your organization. Do not submit blank schedules.)
Is the organization a church?
Is the organization, or any part of it, a school?
Is the organization, or any part of it, a hospital or medical research organization?
Is the organization a section 509(a)(3) supporting organization?
Is the organization a private operating foundation?
Is the organization, or any part of it, a home for the aged or handicapped?
Is the organization, or any part of it, a child care organization?
Does the organization provide or administer any scholarship benefits, student aid, etc.? ....
Has the organization taken over, or will it take over, the facilities of a "for profit" institution? . . .
Yes
No
If "Yes,"
complete
Schedule:
A
B
C
D
E
F
G
H
I
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Form 1023 (Rev. 4-96)
Page 8
Financial Data
Complete the financial statements for the current year and for each of the 3 years immediately before it. If in existence less
than 4 years, complete the statements for each year in existence. If in existence less than 1 year, also provide proposed
budgets for the 2 years following the current year.
A. Statement of Revenue and Expenses
Revenue
Expenses
1 Gifts, grants, and contributions
received (not including unusual
the instructions)
2 Membership fees received . .
3 Gross investment income (see
instructions for definition) . .
4 Net income from organization's
unrelated business activities not
included on line 3
5 Tax revenues levied for and
either paid to or spent on behalf
of the organization ....
6 Value of services or facilities
furnished by a governmental unit
to the organization without charge
(not including the value of services
or facilities generally furnished the
public without charge) ....
7 Other income (not including gain
or loss from sale of capital
assets) (attach schedule) . .
8 Total (add lines 1 through 7)
9 Gross receipts from admissions,
sales of merchandise or services,
or furnishing of facilities in any
activity that is not an unrelated
business within the meaning of
section 513. Include related cost
of sales on line 22.
10 Total (add lines 8 and 9) . .
1 1 Gain or loss from sale of capital
assets (attach schedule) . . .
12 Unusual grants
13 Total revenue (add lines 10
through 12)
14 Fundraising expenses . . .
15 Contributions, gifts, grants, and
similar amounts paid (attach
schedule)
16 Disbursements to or for benefit
of members (attach schedule) .
17 Compensation of officers,
directors, and trustees (attach
schedule)
18 Other salaries and wages . .
19 Interest
20 Occupancy (rent, utilities, etc.) .
21 Depreciation and depletion . .
22 Other (attach schedule) . . .
23 Total expenses (add lines 14
through 22)
24 Excess of revenue over
expenses (line 13 minus line 23)
Current
tax year
(a) From
to
3 prior tax years or proposed budget for 2 years
(b) 19
(c) 19
(d) 19
(e) TOTAL
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Form 1023 (Rev. 4-96)
Page 9
Financial Data (Continued)
B. Balance Sheet (at the end of the period shown)
Current tax year
Date
Assets
1 Cash _J_
2 Accounts receivable, net 2
3 Inventories 3
4 Bonds and notes receivable (attach schedule) 4
5 Corporate stocks (attach schedule) 5
6 Mortgage loans (attach schedule) 6
7 Other investments (attach schedule) 7
8 Depreciable and depletable assets (attach schedule) 8
9 Land _JL_
10 Other assets (attach schedule) 10
11 Total assets (add lines 1 through 10) 11
Liabilities
12 Accounts payable 12
13 Contributions, gifts, grants, etc., payable 13
14 Mortgages and notes payable (attach schedule) 14
15 Other liabilities (attach schedule) 15
16 Total liabilities (add lines 12 through 15) 16
Fund Balances or Net Assets
17 Total fund balances or net assets 17
18 Total liabilities and fund balances or net assets (add line 16 and line 17) .... 18
If there has been any substantial change in any aspect of the organization's financial activities since the end of the period
shown above, check the box and attach a detailed explanation >
-------
Form O/2-tr
(Rev. April 1996)
Department of the Treasury
Internal Revenue Service
Consent Fixing Period of Limitation Upon
Assessment of Tax Under Section 4940 of the
Internal Revenue Code
(See instructions on reverse side.)
OMB No. 1545-0056
To be used with
Form 1023. Submit
in duplicate.
Under section 6501 (c)(4) of the Internal Revenue Code, and as part of a request filed with Form 1023 that the
organization named below be treated as a publicly supported organization under section 170(b)(1)(A)(vi) or section
509(a)(2) during an advance ruling period,
(Exact legal name of organization as shown in organizing document)
(Number, street, city or town, state, and ZIP code)
District Director of
Internal Revenue, or
and the Assistant
Commissioner
(Employee Plans and
Exempt Organizations)
Consent and agree that the period for assessing tax (imposed under section 4940 of the Code) for any of the 5
tax years in the advance ruling period will extend 8 years, 4 months, and 15 days beyond the end of the first tax
year.
However, if a notice of deficiency in tax for any of these years is sent to the organization before the period
expires, the time for making an assessment will be further extended by the number of days the assessment is
prohibited, plus 60 days.
Ending date of first tax year
(Month, day, and year)
Name of organization (as shown in organizing document)
Date
Officer or trustee having authority to sign
Signature ^-
Title ^
For IRS use only
District Director or Assistant Commissioner (Employee Plans and Exempt Organizations)
Date
By
For Paperwork Reduction Act Notice, see page 1 of the Form 1023 Instructions.
Cat. No. 16905Q
-------
Form 872-C (Rev. 4-96) Page 2
You must complete this form and attach it to the Form 1023 if
you checked box h, i, or j of Part III, question 10, and the
organization has not completed a tax year of at least 8 months.
For example: If the organization incorporated May 15 and
its year ends December 31, it has completed
a tax year of only 71/2 months. Therefore,
Form 872-C must be submitted.
(a) Enter the name of the organization. This must be entered
exactly as it appears in the organizing document. Do not use
abbreviations unless the organizing document does.
(b) Enter the current address.
(c) Enter the ending date of the first tax year.
For example:
(1) If the organization was formed on June 15 and it has
chosen December 31 as its year end, enter December 31,
19
(2) If the organization was formed June 15 and it has chosen
June 30 as its year end, enter June 30, 19 In this
example, the organization's first tax year consists of only
15 days.
(d) The form must be signed by an authorized officer or trustee,
generally the president or treasurer.
(e) Enter the date that the form was signed.
DO NOT MAKE ANY OTHER ENTRIES.
-------
Form 1023 (Rev. 4-96) Page 11
Schedule A. Churches
1 Provide a brief history of the development of the organization, including the reasons
for its formation.
2
3
4
5
6
Does the organization have a written creed or statement of faith?. . . . D Yes
If "Yes," attach a copy.
Does the organization require prospective members to renounce other
religious beliefs or their membership in other churches or religious orders
to become members? D Yes
Does the organization have a formal code of doctrine and discipline for
its members? D Yes
If "Yes," describe.
Describe the form of worship and attach a schedule of worship services.
Are the services open to the public? D Yes
DlMo
D No
DlMo
DlMo
If "Yes," describe how the organization publicizes its services and explain the criteria for
admittance.
7 Explain how the organization attracts new members.
8 (a) How many active members are currently enrolled in the church?
(b) What is the average attendance at the worship services?
9 In addition to worship services, what other religious services (such as baptisms, weddings,
funerals, etc.) does the organization conduct?
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Form 1023 (Rev. 4-96) Page 12
Schedule A. Churches (Continued)
10 Does the organization have a school for the religious instruction of the
young? D Yes D No
11 Were the current deacons, minister, and/or pastor formally ordained after
a prescribed course of study? D Yes D No
12 Describe the organization's religious hierarchy or ecclesiastical government.
13 Does the organization have an established place of worship? D Yes D No
If "Yes," provide the name and address of the owner or lessor of the property
and the address and a description of the facility.
If the organization has no regular place of worship, state where the services
are held and how the site is selected.
14 Does (or will) the organization license or otherwise ordain ministers (or their
equivalent) or issue church charters? D Yes D No
If "Yes," describe in detail the requirements and qualifications needed to
be so licensed, ordained, or chartered.
15 Did the organization pay a fee for a church charter? D Yes D No
If "Yes," state the name and address of the organization to which the fee
was paid, attach a copy of the charter, and describe the circumstances
surrounding the chartering.
16 Show how many hours a week the minister/pastor and officers each devote
to church work and the amount of compensation paid to each of them. If
the minister or pastor is otherwise employed, indicate by whom employed,
the nature of the employment, and the hours devoted to that employment.
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Form 1023 (Rev. 4-96)
Page 13
Schedule A. Churches (Continued)
17 Will any funds or property of the organization be used by any officer, director,
employee, minister, or pastor for his or her personal needs or convenience?
Yes
No
If "Yes," describe the nature and circumstances of such use.
18 List any officers, directors, or trustees related by blood or marriage.
19 Give the name of anyone who has assigned income to the organization or
made substantial contributions of money or other property. Specify the
amounts involved.
Instructions
Although a church, its integrated auxiliaries, or a
convention or association of churches is not required
to file Form 1023 to be exempt from Federal income
tax or to receive tax-deductible contributions, such an
organization may find it advantageous to obtain
recognition of exemption. In this event, you should
submit information showing that your organization is a
church, synagogue, association or convention of
churches, religious order or religious organization that
is an integral part of a church, and that it is carrying
out the functions of a church.
In determining whether an admittedly religious
organization is also a church, the IRS does not accept
any and every assertion that such an organization is a
church. Because beliefs and practices vary so widely,
there is no single definition of the word "church" for
tax purposes. The IRS considers the facts and
circumstances of each organization applying for church
status.
The IRS maintains two basic guidelines in
determining that an organization meets the religious
purposes test:
1. That the particular religious beliefs of the
organization are truly and sincerely held, and
2. That the practices and rituals associated with the
organization's religious beliefs or creed are not illegal
or contrary to clearly defined public policy.
In order for the IRS to properly evaluate your
organization's activities and religious purposes, it is
important that all questions in Schedule A be
answered accurately.
The information submitted with Schedule A will be a
determining factor in granting the "church" status
requested by your organization. In completing the
schedule, consider the following points:
1. The organization's activities in furtherance of its
beliefs must be exclusively religious, and
2. An organization will not qualify for exemption if it
has a substantial nonexempt purpose of serving the
private interests of its founder or the founder's family.
-------
Form 1023 (Rev. 4-96) Page 15
Schedule B. Schools, Colleges, and Universities
1 Does, or will, the organization normally have: (a) a regularly scheduled curriculum, (b) a regular faculty
of qualified teachers, (c) a regularly enrolled student body, and (d) facilities where its educational activities
are regularly carried on? d Yes d No
If "No," do not complete the rest of Schedule B.
2 Is the organization an instrumentality of a state or political subdivision of a state? d Yes d No
If "Yes," document this in Part II and do not complete items 3 through 10 of Schedule B. (See instructions
on the back of Schedule B.)
3 Does or will the organization (or any department or division within it) discriminate in any way on the basis
of race with respect to:
a Admissions? d Yes d No
b Use of facilities or exercise of student privileges? d Yes d No
c Faculty or administrative staff? d Yes d No
d Scholarship or loan programs? d Yes d No
If "Yes" for any of the above, explain.
4 Does the organization include a statement in its charter, bylaws, or other governing instrument, or in a
resolution of its governing body, that it has a racially nondiscriminatory policy as to students?. . . . d Yes d No
Attach whatever corporate resolutions or other official statements the organization has made on this
subject.
5a Has the organization made its racially nondiscriminatory policies known in a manner that brings the
policies to the attention of all segments of the general community that it serves? d Yes d No
If "Yes," describe how these policies have been publicized and how often relevant notices or
announcements have been made. If no newspaper or broadcast media notices have been used, explain.
b If applicable, attach clippings of any relevant newspaper notices or advertising, or copies of tapes or
scripts used for media broadcasts. Also attach copies of brochures and catalogues dealing with student
admissions, programs, and scholarships, as well as representative copies of all written advertising used
as a means of informing prospective students of the organization's programs.
6 Attach a numerical schedule showing the racial composition, as of the current academic year, and projected to the extent
feasible for the next academic year, of: (a) the student body, and (b) the faculty and administrative staff.
7 Attach a list showing the amount of any scholarship and loan funds awarded to students enrolled and the racial composition
of the students who have received the awards.
8a Attach a list of the organization's incorporators, founders, board members, and donors of land or buildings, whether individuals
or organizations.
b State whether any of the organizations listed in 8a have as an objective the maintenance of segregated public or private
school education, and, if so, whether any of the individuals listed in 8a are officers or active members of such organizations.
9a Enter the public school district and county in which the organization is located.
b Was the organization formed or substantially expanded at the time of public school desegregation in the
above district or county? d Yes d No
10 Has the organization ever been determined by a state or Federal administrative agency or judicial body
to be racially discriminatory? d Yes d No
If "Yes," attach a detailed explanation identifying the parties to the suit, the forum in which the case was
heard, the cause of action, the holding in the case, and the citations (if any) for the case. Also describe
in detail what changes in the organization's operation, if any, have occurred since then.
For more information, see back of Schedule B.
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Form 1023 (Rev. 4-96)
Page 16
Instructions
A "school" is an organization that has the primary
function of presenting formal instruction, normally
maintains a regular faculty and curriculum, normally
has a regularly enrolled student body, and has a place
where its educational activities are carried on. The
term generally corresponds to the definition of an
"educational organization" in section 170(b)(1)(A)(ii).
Thus, the term includes primary, secondary,
preparatory and high schools, and colleges and
universities. The term does not include organizations
engaged in both educational and noneducational
activities unless the latter are merely incidental to the
educational activities. A school for handicapped
children is included within the term, but an
organization merely providing handicapped children
with custodial care is not.
For purposes of Schedule B, "Sunday schools" that
are conducted by a church are not included in the
term "schools," but separately organized schools (such
as parochial schools, universities, and similar
institutions) are included in the term.
A private school that otherwise meets the
requirements of section 501 (c)(3) as an educational
institution will not qualify for exemption under section
501 (a) unless it has a racially nondiscriminatory policy
as to students. This policy means that the school
admits students of any race to all the rights, privileges,
programs, and activities generally accorded or made
available to students at that school and that the school
does not discriminate on the basis of race in the
administration of its educational policies, admissions
policies, scholarship and loan programs, and athletic or
other school-administered programs. The IRS
considers discrimination on the basis of race to include
discrimination on the basis of color and national or
ethnic origin. A policy of a school that favors racial
minority groups in admissions, facilities, programs, and
financial assistance will not constitute discrimination on
the basis of race when the purpose and effect is to
promote the establishment and maintenance of that
school's racially nondiscriminatory policy as to
students. See Rev. Proc. 75-50, 1975-2 C.B. 587, for
guidelines and recordkeeping requirements for
determining whether private schools that are applying
for recognition of exemption have racially
nondiscriminatory policies as to students.
Line 2
An instrumentality of a state or political subdivision of
a state may qualify under section 501(c)(3) if it is
organized as a separate entity from the governmental
unit that created it and if it otherwise meets the
organizational and operational tests of section
501(c)(3). (See Rev. Rul. 60-384, 1960-2 C.B. 172.) Any
such organization that is a school is not a private
school and, therefore, is not subject to the provisions
of Rev. Proc. 75-50.
Schools that incorrectly answer "Yes" to line 2 will
be contacted to furnish the information called for by
lines 3 through 10 in order to establish that they meet
the requirements for exemption. To prevent delay in the
processing of your application, be sure to answer line
2 correctly and complete lines 3 through 10, if
applicable.
-------
Form 1023 (Rev. 4-96) Page 17
Schedule C. Hospitals and Medical Research Organizations
CH Check here if claiming to be a hospital; complete the questions in Section I of this schedule; and write "N/A" in Section II.
CH Check here if claiming to be a medical research organization operated in conjunction with a hospital; complete the
questions in Section II of this schedule; and write "N/A" in Section I.
Hospitals
1a How many doctors are on the hospital's courtesy staff?
b Are all the doctors in the community eligible for staff privileges? I I Yes I I No
If "No," give the reasons why and explain how the courtesy staff is selected.
2a Does the hospital maintain a full-time emergency room? I I Yes I I No
b What is the hospital's policy on administering emergency services to persons without apparent means
to pay?
c Does the hospital have any arrangements with police, fire, and voluntary ambulance services for the
delivery or admission of emergency cases? I I Yes I I No
Explain.
3a Does or will the hospital require a deposit from persons covered by Medicare or Medicaid in its admission
practices? I I Yes I I No
If "Yes," explain.
b Does the same deposit requirement, if any, apply to all other patients? I I Yes I I No
If "No," explain.
4 Does or will the hospital provide for a portion of its services and facilities to be used for charity patients? I I Yes I I No
Explain the policy regarding charity cases. Include data on the hospital's past experience in admitting
charity patients and arrangements it may have with municipal or government agencies for absorbing the
cost of such care.
5 Does or will the hospital carry on a formal program of medical training and research? I I Yes I I No
If "Yes," describe.
Does the hospital provide office space to physicians carrying on a medical practice? I I Yes I I No
If "Yes," attach a list setting forth the name of each physician, the amount of space provided, the annual
rent, the expiration date of the current lease and whether the terms of the lease represent fair market value.
Medical Research Organizations
Section II
1 Name the hospitals with which the organization has a relationship and describe the relationship.
2 Attach a schedule describing the organization's present and proposed (indicate which) medical research activities; show
the nature of the activities, and the amount of money that has been or will be spent in carrying them out. (Making grants to
other organizations is not direct conduct of medical research.)
3 Attach a statement of assets showing their fair market value and the portion of the assets directly devoted to medical
research.
For more information, see back of Schedule C.
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Form 1023 (Rev. 4-96)
Page 18
Additional Information
Hospitals
To be entitled to status as a "hospital," an organization
must have, as its principal purpose or function, the
providing of medical or hospital care or medical
education or research. "Medical care" includes the
treatment of any physical or mental disability or
condition, the cost of which may be taken as a
deduction under section 213, whether the treatment is
performed on an inpatient or outpatient basis. Thus, a
rehabilitation institution, outpatient clinic, or community
mental health or drug treatment center may be a
hospital if its principal function is providing the
above-described services.
On the other hand, a convalescent home or a home
for children or the aged is not a hospital. Similarly, an
institution whose principal purpose or function is to
train handicapped individuals to pursue some vocation
is not a hospital. Moreover, a medical education or
medical research institution is not a hospital, unless it
is also actively engaged in providing medical or
hospital care to patients on its premises or in its
facilities on an inpatient or outpatient basis.
Cooperative Hospital Service Organizations
Cooperative hospital service organizations (section
501 (e)) should not complete Schedule C.
Medical Research Organizations
To qualify as a medical research organization, the
principal function of the organization must be the
direct, continuous, and active conduct of medical
research in conjunction with a hospital that is
described in section 501(c)(3), a Federal hospital, or an
instrumentality of a governmental unit referred to in
section 170(c)(1). For purposes of section
170(b)(1)(A)(iii) only, the organization must be set up to
use the funds it receives in the active conduct of
medical research by January 1 of the fifth calendar
year after receipt. The arrangement it has with donors
to assure use of the funds within the 5-year period
must be legally enforceable. As used here, "medical
research" means investigations, experiments, and
studies to discover, develop, or verify knowledge
relating to the causes, diagnosis, treatment,
prevention, or control of human physical or mental
diseases and impairments. For further information, see
Regulations section 1.170A-9(c)(2).
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Form 1023 (Rev. 4-96)
Page 19
Schedule D. Section 509(a)(3) Supporting Organizations
1a Organizations supported by the applicant organization:
Name and address of supported organization
b Has the supported organization
or determination letter that it is
foundation by reason of section
D Yes D
D Yes D
D Yes D
D Yes D
D Yes D
received a ruling
not a private
509(a)(1) or (2)?
No
No
No
No
No
c If "No" for any of the organizations listed in 1a, explain.
2 Does the supported organization have tax-exempt status under section 501(c)(4), 501(c)(5), or 501(c)(6)? I I Yes I I No
If "Yes," attach: (a) a copy of its ruling or determination letter, and (b) an analysis of its revenue for the
current year and the preceding 3 years. (Provide the financial data using the formats in Part IV-A (lines
1-13) and Part III (lines 12, 13, and 14).)
3 Does your organization's governing document indicate that the majority of its governing board is elected
or appointed by the supported organizations? CH Yes CH No
If "Yes," skip to line 9.
If "No," you must answer the questions on lines 4 through 9.
4 Does your organization's governing document indicate the common supervision or control that it and the
supported organizations share?
If "Yes," give the article and paragraph numbers. If "No," explain.
Yes U No
5 To what extent do the supported organizations have a significant voice in your organization's investment policies, in the making
and timing of grants, and in otherwise directing the use of your organization's income or assets?
6 Does the mentioning of the supported organizations in your organization's governing instrument make it
a trust that the supported organizations can enforce under state law and compel to make an accounting? CH Yes CH No
If "Yes," explain.
7a What percentage of your organization's income does it pay to each supported organization?
b What is the total annual income of each supported organization?
c How much does your organization contribute annually to each supported organization?
For more information, see back of Schedule D.
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Form 1023 (Rev. 4-96) Page 20
Schedule D. Section 509(a)(3) Supporting Organizations (Continued)
8 To what extent does your organization conduct activities that would otherwise be carried on by the supported organizations?
Explain why these activities would otherwise be carried on by the supported organizations.
9 Is the applicant organization controlled directly or indirectly by one or more "disqualified persons" (other
than one who is a disqualified person solely because he or she is a manager) or by an organization that
is not described in section 509(a)(1) or (2)? d Yes d No
If "Yes," explain.
Instructions
For an explanation of the types of organizations Line 3
defined in section 509(a)(3) as being excluded from the .. . . ,
definition of a private foundation, see Pub. 557, Your, organization s governing document may be
Chanter 3 articles of incorporation, articles of association,
constitution, trust indenture, or trust agreement.
Line 1 Line 9
List each organization that is supported by your ._ . ,. . . , .. .... . _ ._
organization and indicate in item 1b if the supported ,Forta definition of a disqualified person, see Spec,f,c
organization has received a letter recognizing exempt Instructions, Part II, Line 4d, on page 3 of the
status as a section 501(c)(3) public charity as defined application s instructions.
in section 509(a)(1) or 509(a)(2). If you answer "No" in
1b to any of the listed organizations, please explain in
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Form 1023 (Rev. 4-96)
Page 21
Schedule E. Private Operating Foundations
Income Test
1a Adjusted net income, as defined in Regulations section 53.4942(a)-2(d)
b Minimum investment return, as defined in Regulations section 53.4942(a)-2(c)
2 Qualifying distributions:
a Amounts (including administrative expenses) paid directly for the active conduct of the activities for
which organized and operated under section 501 (c)(3) (attach schedule)
b Amounts paid to acquire assets to be used (or held for use) directly in carrying out purposes described
in section 170(c)(1) or 170(c)(2)(B) (attach schedule)
c Amounts set aside for specific projects that are for purposes described in section 170(c)(1) or
170(c)(2)(B) (attach schedule)
d Total qualifying distributions (add lines 2a, b, and c)
3 Percentages:
a Percentage of qualifying distributions to adjusted net income (divide line 2d by line 1a)
b Percentage of qualifying distributions to minimum investment return (divide line 2d by line 1b). . .
(Percentage must be at least 85% for 3a or 3b)
Assets Test
4 Value of organization's assets used in activities that directly carry out the exempt purposes. Do not
include assets held merely for investment or production of income (attach schedule)
5 Value of any stock of a corporation that is controlled by applicant organization and carries out its
exempt purposes (attach statement describing corporation)
6 Value of all qualifying assets (add lines 4 and 5)
7 Value of applicant organization's total assets
8 Percentage of qualifying assets to total assets (divide line 6 by line 7percentage must exceed 65%)
Endowment Test
9 Value of assets not used (or held for use) directly in carrying out exempt purposes:
a Monthly average of investment securities at fair market value
b Monthly average of cash balances
c Fair market value of all other investment property (attach schedule)
d Total (add lines 9a, b, and c)
10 Acquisition indebtedness related to line 9 items (attach schedule)
11 Balance (subtract line 10 from line 9d)
12 Multiply line 11 by 3Vs% (% of the percentage for the minimum investment return computation under
section 4942(e)). Line 2d above must equal or exceed the result of this computation
Support Test
13 Applicant organization's support as defined in section 509(d)
14 Gross investment income as defined in section 509(e)
15 Support for purposes of section 4942(j)(3)(B)(iii) (subtract line 14 from line 13)
16 Support received from the general public, five or more exempt organizations, or a combination of
these sources (attach schedule)
17 For persons (other than exempt organizations) contributing more than 1% of line 15, enter the total
amounts that are more than 1% of line 15
18 Subtract line 17 from line 16
19 Percentage of total support (divide line 18 by line 15must be at least 85%)
20 Does line 16 include support from an exempt organization that is more than 25% of the amount of
line 15?
Most recent
tax year
la
1b
2a
2b
2c
2d
3a
3b
4
5
6
7
8
9a
9b
9c
9d
10
11
12
13
14
15
16
17
18
19
%
%
%
%
Yes
No
21 Newly created organizations with less than 1 year's experience: Attach a statement explaining how the organization is planning
to satisfy the requirements of section 4942(j)(3) for the income test and one of the supplemental tests during its first year's
operation. Include a description of plans and arrangements, press clippings, public announcements, solicitations for funds,
etc.
22 Does the amount entered on line 2a above include any grants that the applicant organization made? CH Yes CH No
If "Yes," attach a statement explaining how those grants satisfy the criteria for "significant involvement"
grants described in section 53.4942(b)-1(b)(2) of the regulations.
For more information, see back of Schedule E.
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Form 1023 (Rev. 4-96)
Page 22
Instructions
If the organization claims to be an operating foundation
described in section 4942(j)(3) and
a. Bases its claim to private operating foundation
status on normal and regular operations over a period
of years; or
b. Is newly created, set up as a private operating
foundation, and has at least 1 year's experience;
provide the information under the income test and
under one of the three supplemental tests (assets,
endowment, or support). If the organization does not
have at least 1 year's experience, provide the
information called for on line 21. If the organization's
private operating foundation status depends on its
normal and regular operations as described in a above,
attach a schedule similar to Schedule E showing the
data in tabular form for the 3 years preceding the most
recent tax year. (See Regulations section 53.4942(b)-1
for additional information before completing the
"Income Test" section of this schedule.) Organizations
claiming section 4942(j)(5) status must satisfy the
income test and the endowment test.
A "private operating foundation" described in section
4942(j)(3) is a private foundation that spends
substantially all of the smaller of its adjusted net
income (as defined below) or its minimum investment
return directly for the active conduct of the activities
constituting the purpose or function for which it is
organized and operated. The foundation must satisfy
the income test under section 4942(j)(3)(A), as modified
by Regulations section 53.4942(b)-1, and one of the
following three supplemental tests: (1) the assets test
under section 4942(j)(3)(B)(i); (2) the endowment test
under section 4942(j)(3)(B)(ii); or (3) the support test
under section 4942(j)(3)(B)(iii).
Certain long-term care facilities described in section
4942(j)(5) are treated as private operating foundations
for purposes of section 4942 only.
"Adjusted net income" is the excess of gross income
determined with the income modifications described
below for the tax year over the sum of deductions
determined with the deduction modifications described
below. Items of gross income from any unrelated trade
or business and the deductions directly connected
with the unrelated trade or business are taken into
account in computing the organization's adjusted net
income.
Income Modifications
The following are income modifications (adjustments to
gross income):
1. Section 103 (relating to interest on certain
governmental obligations) does not apply. Thus,
interest that otherwise would have been excluded
should be included in gross income.
2. Except as provided in 3 below, capital gains and
losses are taken into account only to the extent of the
net short-term gain. Long-term gains and losses are
disregarded.
3. The gross amount received from the sale or
disposition of certain property should be included in
gross income to the extent that the acquisition of the
property constituted a qualifying distribution under
section 4942(g)(1)(B).
4. Repayments of prior qualifying distributions (as
defined in section 4942(g)(1)(A)) constitute items of
gross income.
5. Any amount set aside under section 4942(g)(2)
that is "not necessary for the purposes for which it
was set aside" constitutes an item of gross income.
Deduction Modifications
The following are deduction modifications (adjustments
to deductions):
1. Expenses for the general operation of the
organization according to its charitable purposes (as
contrasted with expenses for the production or
collection of income and management, conservation,
or maintenance of income-producing property) should
not be taken as deductions. If only a portion of the
property is used for production of income subject to
section 4942 and the remainder is used for general
charitable purposes, the expenses connected with that
property should be divided according to those
purposes. Only expenses related to the income-
producing portion should be taken as deductions.
2. Charitable contributions, deductible under section
170 or 642(c), should not be taken into account as
deductions for adjusted net income.
3. The net operating loss deduction prescribed under
section 172 should not be taken into account as a
deduction for adjusted net income.
4. The special deductions for corporations (such as
the dividends-received deduction) allowed under
sections 241 through 249 should not be taken into
account as deductions for adjusted net income.
5. Depreciation and depletion should be determined
in the same manner as under section 4940(c)(3)(B).
Section 265 (relating to the expenses and interest
connected with tax-exempt income) should not be
taken into account.
You may find it easier to figure adjusted net income
by completing column (c), Part 1, Form 990-PF,
according to the instructions for that form.
An organization that has been held to be a private
operating foundation will continue to be such an
organization only if it meets the income test and either
the assets, endowment, or support test in later years.
See Regulations section 53.4942(b) for additional
information. No additional request for ruling will be
necessary or appropriate for an organization to
maintain its status as a private operating foundation.
However, data related to the above tests must be
submitted with the organization's annual information
return, Form 990-PF.
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Form 1023 (Rev. 4-96) Page 23
Schedule F. Homes for the Aged or Handicapped
1 What are the requirements for admission to residency? Explain fully and attach promotional literature and application forms.
2 Does or will the home charge an entrance or founder's fee? I I Yes I I No
If "Yes," explain and specify the amount charged.
3 What periodic fees or maintenance charges are or will be required of its residents?
4a What established policy does the home have concerning residents who become unable to pay their regular charges?
b What arrangements does the home have or will it make with local and Federal welfare units, sponsoring organizations, or
others to absorb all or part of the cost of maintaining those residents?
5 What arrangements does or will the home have to provide for the health needs of its residents?
6 In what way are the home's residential facilities designed to meet some combination of the physical, emotional, recreational,
social, religious, and similar needs of the aged or handicapped?
7 Provide a description of the home's facilities and specify both the residential capacity of the home and the current number
of residents.
8 Attach a sample copy of the contract or agreement the organization makes with or requires of its residents.
For more information, see back of Schedule F.
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Form 1023 (Rev. 4-96)
Page 24
Instructions
Line 1
Provide the criteria for admission to the home
and submit brochures, pamphlets, or other
printed material used to inform the public
about the home's admissions policy.
Line 2
Indicate whether the fee charged is an
entrance fee or a monthly charge, etc. Also, if
the fee is an entrance fee, is it payable in a
lump sum or on an installment basis?
Line 4
Indicate the organization's policy regarding
residents who are unable to pay. Also,
indicate whether the organization is
subsidized for all or part of the cost of
maintaining those residents who are unable to
pay.
Line 5
Indicate whether the organization provides
health care to the residents, either directly or
indirectly, through some continuing
arrangement with other organizations,
facilities, or health personnel. If no health
care is provided, indicate "N/A."
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Form 1023 (Rev. 4-96) Page 25
Schedule G. Child Care Organizations
1 Is the organization's primary activity the providing of care for children away
from their homes? D Yes D No
2 How many children is the organization authorized to care for by the state (or local governmental
unit), and what was the average attendance during the past 6 months, or the number of months
the organization has been in existence if less than 6 months?
3 How many children are currently cared for by the organization?
4 Is substantially all (at least 85%) of the care provided for the purpose of
enabling parents to be gainfully employed or to seek employment? . . . D Yes D No
5 Are the services provided available to the general public? D Yes D No
If "No," explain.
6 Indicate the category, or categories, of parents whose children are eligible for the child care
services (check as many as apply):
D low-income parents
D any working parents (or parents looking for work)
D anyone with the ability to pay
D other (explain)
Instructions
Line 5 REMINDERIf this organization claims to
If your organization's services are not available operate a school, then it must also fill out
to the general public, indicate the particular Schedule B.
group or groups that may utilize the services.
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Form 1023 (Rev. 4-96) Page 27
Schedule H. Organizations Providing Scholarship Benefits, Student Aid, etc., to Individuals
1a Describe the nature and the amount of the scholarship benefit, student aid, etc., including the terms and conditions governing
its use, whether a gift or a loan, and how the availability of the scholarship is publicized. If the organization has established
or will establish several categories of scholarship benefits, identify each kind of benefit and explain how the organization
determines the recipients for each category. Attach a sample copy of any application the organization requires individuals to
complete to be considered for scholarship grants, loans, or similar benefits. (Private foundations that make grants for travel,
study, or other similar purposes are required to obtain advance approval of scholarship procedures. See Regulations sections
53.4945-4(c) and (d).)
b If you want this application considered as a request for approval of grant procedures in the event we determine that the
organization is a private foundation, check here > d
c If you checked the box in 1b above, check the boxes for which you wish the organization to be considered.
D 4945(g)(1) D 4945(g)(2) D 4945(g)(3)
2 What limitations or restrictions are there on the class of individuals who are eligible recipients? Specifically explain whether
there are, or will be, any restrictions or limitations in the selection procedures based upon race or the employment status of
the prospective recipient or any relative of the prospective recipient. Also indicate the approximate number of eligible individuals.
3 Indicate the number of grants the organization anticipates making annually
4 If the organization bases its selections in any way on the employment status of the applicant or any relative of the applicant,
indicate whether there is or has been any direct or indirect relationship between the members of the selection committee and
the employer. Also indicate whether relatives of the members of the selection committee are possible recipients or have been
recipients.
5 Describe any procedures the organization has for supervising grants (such as obtaining reports or transcripts) that it awards
and any procedures it has for taking action if the terms of the grant are violated.
For more information, see back of Schedule H.
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Form 1023 (Rev. 4-96)
Page 28
Additional Information
Private foundations that make grants to
individuals for travel, study, or other similar
purposes are required to obtain advance
approval of their grant procedures from the
IRS. Such grants that are awarded under
selection procedures that have not been
approved by the IRS are subject to a 10%
excise tax under section 4945. (See
Regulations sections 53.4945-4(c) and (d).)
If you are requesting advance approval of
the organization's grant procedures, the
following sections apply to line 1c:
4945(g)(1) The grant constitutes a
scholarship or fellowship grant that
meets the provisions of section
117(a) prior to its amendment by
the Tax Reform Act of 1986 and is
to be used for study at an
educational organization (school)
described in section 170(b)(1)(A)(ii).
4945(g)(2)The grant constitutes a prize or
award that is subject to the
provisions of section 74(b), if the
recipient of such a prize or award
is selected from the general public.
4945(g)(3)The purpose of the grant is to
achieve a specific objective,
produce a report or other similar
product, or improve or enhance a
literary, artistic, musical, scientific,
teaching, or other similar capacity,
skill, or talent of the grantee.
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Form 1023 (Rev. 4-96)
Page 29
Schedule I. Successors to "For Profit" Institutions
1 What was the name of the predecessor organization and the nature of its activities?
2 Who were the owners or principal stockholders of the predecessor organization? (If more space is needed, attach
schedule.)
Name and address
Share or interest
3 Describe the business or family relationship between the owners or principal stockholders and principal employees of the
predecessor organization and the officers, directors, and principal employees of the applicant organization.
4a Attach a copy of the agreement of sale or other contract that sets forth the terms and conditions of sale of the predecessor
organization or of its assets to the applicant organization.
b Attach an appraisal by an independent qualified expert showing the fair market value at the time of sale of the facilities or
property interest sold.
5 Has any property or equipment formerly used by the predecessor organization been rented to the applicant
organization or will any such property be rented? CH Yes
If "Yes," explain and attach copies of all leases and contracts.
No
6 Is the organization leasing or will it lease or otherwise make available any space or equipment to the
owners, principal stockholders, or principal employees of the predecessor organization? d Yes d No
If "Yes," explain and attach a list of these tenants and a copy of the lease for each such tenant.
7 Were any new operating policies initiated as a result of the transfer of assets from a profit-making
organization to a nonprofit organization? CH Yes CH No
If "Yes," explain.
Additional Information
A "for profit" institution for purposes of Schedule I
includes any organization in which a person may have
a proprietary or partnership interest, hold corporate
stock, or otherwise exercise an ownership interest. The
institution need not have operated for the purpose of
making a profit.
-------
Activity Code Numbers of Exempt Organizations (select up to three codes that best describe or most accurately identify your organization's purposes,
activities, operations or type of organization and enter in block 6, page 1, of the application. Enter first the code that most accurately identifies the organization.)
Code
Religious Activities
001 Church, synagogue, etc.
002 Association or convention of churches
003 Religious order
004 Church auxiliary
005 Mission
006 Missionary activities
007 Evangelism
008 Religious publishing activities
--- Bookstore (use 918)
--- Genealogical activities (use 094)
029 Other religious activities
Schools, Colleges, and Related Activities
030 School, college, trade school, etc.
031 Special school for the blind,
handicapped, etc.
032 Nursery school
Day care center (use 574)
033 Faculty group
034 Alumni association or group
035 Parent or parent-teachers association
036 Fraternity or sorority
--- Key club (use 323)
037 Other student society or group
038 School or college athletic association
039 Scholarships for children of employees
040 Scholarships (other)
041 Student loans
042 Student housing activities
043 Other student aid
044 Student exchange with foreign country
045 Student operated business
Financial support of schools, colleges,
etc. (use 602)
Achievement prizes or awards (use 914)
--- Student bookstore (use 918)
--- Student travel (use 299)
--- Scientific research (see Scientific
Research Activities)
046 Private school
059 Other school related activities
Cultural, Historical or Other Educational
Activities
060 Museum, zoo, planetarium, etc.
061 Library
062 Historical site, records, or reenactment
063 Monument
064 Commemorative event (centennial,
festival, pageant, etc.)
065 Fair
088 Community theatrical group
089 Singing society or group
090 Cultural performances
091 Art exhibit
092 Literary activities
093 Cultural exchanges with foreign country
094 Genealogical activities
- - - Achievement prizes or awards (use 914)
Gifts or grants to individuals (use 561)
- - - Financial support of cultural
organizations (use 602)
119 Other cultural or historical activities
Other Instruction and Training Activities
120 Publishing activities
121 Radio or television broadcasting
122 Producing films
123 Discussion groups, forums, panels,
lectures, etc.
124 Study and research (nonscientific)
125 Giving information or opinion
(see also Advocacy)
126 Apprentice training
--- Travel tours (use 299)
149 Other instruction and training
Health Services and Related Activities
150 Hospital
151 Hospital auxiliary
152 Nursing or convalescent home
153 Care and housing for the aged
(see also 382)
154 Health clinic
155 Rural medical facility
156 Blood bank
157 Cooperative hospital service
organization
158 Rescue and emergency service
159 Nurses register or bureau
160 Aid to the handicapped (see also 031)
161 Scientific research (diseases)
162 Other medical research
163 Health insurance (medical, dental,
optical, etc.)
164 Prepared group health plan
165 Community health planning
166 Mental health care
167 Group medical practice association
168 In-faculty group practice association
169 Hospital pharmacy, parking facility,
food services, etc.
179 Other health services
Scientific Research Activities
180 Contract or sponsored scientific
research for industry
Code
181 Scientific research for government
Scientific research (diseases) (use 161)
199 Other scientific research activities
Business and Professional Organizations
200 Business promotion (chamber of
commerce, business league, etc.)
201 Real estate association
202 Board of trade
203 Regulating business
204 Promotion of fair business practices
205 Professional association
206 Professional association auxiliary
207 Industry trade shows
208 Convention displays
--- Testing products for public safety
(use 905)
209 Research, development, and testing
210 Professional athletic league
--- Attracting new industry (use 403)
--- Publishing activities (use 120)
Insurance or other benefits for
members (see Employee or
Membership Benefit Organizations)
211 Underwriting municipal insurance
212 Assigned risk insurance activities
213 Tourist bureau
229 Other business or professional group
Farming and Related Activities
230 Farming
231 Farm bureau
232 Agricultural group
233 Horticultural group
234 Farmers cooperative marketing or
purchasing
235 Financing crop operations
--- FFA, FHA, 4-H club, etc. (use 322)
--- Fair (use 065)
236 Dairy herd improvement association
237 Breeders association
249 Other farming and related activities
Mutual Organizations
250 Mutual ditch, irrigation, telephone,
electric company, or like organization
251 Credit union
252 Reserve funds or insurance for
domestic building and loan
association, cooperative bank,
or mutual savings bank
253 Mutual insurance company
254 Corporation organized under an
Act of Congress (see also 904)
--- Farmers cooperative marketing or
purchasing (use 234)
--- Cooperative hospital service
organization (use 157)
259 Other mutual organization
Employee or Membership Benefit
Organizations
260 Fraternal beneficiary society, order,
or association
261 Improvement of conditions of workers
262 Association of municipal employees
263 Association of employees
264 Employee or member welfare
association
265 Sick, accident, death, or similar
benefits
266 Strike benefits
267 Unemployment benefits
268 Pension or retirement benefits
269 Vacation benefits
279 Other services or benefits to
members or employees
Sports, Athletic, Recreational, and
Social Activities
280 Country club
281 Hobby club
282 Dinner club
283 Variety club
284 Dog club
285 Women's club
--- Garden club (use 356)
286 Hunting or fishing club
287 Swimming or tennis club
288 Other sports club
--- Boys Club, Little League, etc. (use 321)
296 Community center
297 Community recreational facilities
(park, playground, etc.)
298 Training in sports
299 Travel tours
300 Amateur athletic association
--- School or college athletic association
(use 038)
301 Fundraising athletic or sports event
317 Other sports or athletic activities
318 Other recreational activities
319 Other social activities
Youth Activities
320 Boy Scouts, Girl Scouts, etc.
321 Boys Club, Little League, etc.
Code
322 FFA, FHA, 4-H club, etc.
323 Key club
324 YMCA, YWCA, YMHA, etc.
325 Camp
326 Care and housing of children
(orphanage, etc.)
327 Prevention of cruelty to children
328 Combat juvenile delinquency
349 Other youth organization or activities
Conservation, Environmental, and
Beautification Activities
350 Preservation of natural resources
(conservation)
351 Combating or preventing pollution
(air, water, etc.)
352 Land acquisition for preservation
353 Soil or water conservation
354 Preservation of scenic beauty
--- Litigation (see Litigation and Legal
Aid Activities)
- - - Combat community deterioration
(use 402)
355 Wildlife sanctuary or refuge
356 Garden club
379 Other conservation, environmental,
or beautification activities
Housing Activities
380 Low-income housing
381 Low and moderate income housing,
382 Housing for the aged (see also 153)
--- Nursing or convalescent home
(use 152)
--- Student housing (use 042)
Orphanage (use 326)
398 Instruction and guidance on housing
399 Other housing activities
Inner City or Community Activities
400 Area development, redevelopment,
or renewal
Housing (see Housing Activities)
401 Homeowners association
402 Other activity aimed at combating
community deterioration
403 Attracting new industry or retaining
industry in an area
404 Community promotion
--- Community recreational facility
(use 297)
-- Community center (use 296)
405 Loans or grants for minority businesses
--- Job training, counseling, or
assistance (use 566)
-- Day care center (use 574)
Referral service (social agencies)
(use 569)
Legal aid to indigents (use 462)
406 Crime prevention
407 Voluntary firemen's organization or
auxiliary
Rescue squad (use 158)
408 Community service organization
429 Other inner city or community
benefit activities
Civil Rights Activities
430 Defense of human and civil rights
431 Elimination of prejudice and
discrimination (race, religion,
sex, national origin, etc.)
432 Lessen neighborhood tensions
449 Other civil rights activities
Litigation and Legal Aid Activities
460 Public interest litigation activities
461 Other litigation or support of litigation
462 Legal aid to indigents
463 Providing bail
Legislative and Political Activities
480 Propose, support, or oppose legislation
481 Voter information on issues or
candidates
482 Voter education (mechanics of
registering, voting, etc.)
483 Support, oppose, or rate political
candidates
484 Provide facilities or services for
political campaign activities
509 Other legislative and political activities
Advocacy
Attempt to influence public opinion
concerning:
510 Firearms control
511 Selective Service System
512 National defense policy
513 Weapons systems
514 Government spending
515 Taxes or tax exemption
516 Separation of church and state
517 Government aid to parochial schools
518 U.S. foreign policy
519 U.S. military involvement
Code
520 Pacifism and peace
521 Economic-political system of U.S.
522 Anti-communism
523 Right to work
524 Zoning or rezoning
525 Location of highway or transportation
system
526 Rights of criminal defendants
527 Capital punishment
528 Stricter law enforcement
529 Ecology or conservation
530 Protection of consumer interests
531 Medical care service
532 Welfare system
533 Urban renewal
534 Busing students to achieve racial
balance
535 Racial integration
536 Use of intoxicating beverages
537 Use of drugs or narcotics
538 Use of tobacco
539 Prohibition of erotica
540 Sex education in public schools
541 Population control
542 Birth control methods
543 Legalized abortion
559 Other matters
Other Activities Directed to Individuals
560 Supplying money, goods, or services
to the poor
561 Gifts or grants to individuals (other
than scholarships)
Scholarships for children of
employees (use 039)
Scholarships (other) (use 040)
--- Student loans (use 041)
562 Other loans to individuals
563 Marriage counseling
564 Family planning
565 Credit counseling and assistance
566 Job training, counseling, or assistance
567 Draft counseling
568 Vocational counseling
569 Referral service (social agencies)
572 Rehabilitating convicts or ex-convicts
573 Rehabilitating alcoholics, drug
abusers, compulsive gamblers, etc.
574 Day care center
575 Services for the aged (see also 153
and 382)
Training of or aid to the handicapped
(see 031 and 160)
Activities Directed to Other Organizations
600 Community Chest, United Way, etc.
601 Booster club
602 Gifts, grants, or loans to other
organizations
603 Nonfinancial services or facilities to
other organizations
Other Purposes and Activities
900 Cemetery or burial activities
901 Perpetual care fund (cemetery,
columbarium, etc.)
902 Emergency or disaster aid fund
903 Community trust or component
904 Government instrumentality or
agency (see also 254)
905 Testing products for public safety
906 Consumer interest group
907 Veterans activities
908 Patriotic activities
909 4947(a)(1) trust
910 Domestic organization with activities
outside U.S.
911 Foreign organization
912 Title holding corporation
913 Prevention of cruelty to animals
914 Achievement prizes or awards
915 Erection or maintenance of public
building or works
916 Cafeteria, restaurant, snack bar,
food services, etc.
917 Thrift shop, retail outlet, etc.
918 Book, gift, or supply store
919 Advertising
920 Association of employees
921 Loans or credit reporting
922 Endowment fund or financial services
923 Indians (tribes, cultures, etc.)
924 Traffic or tariff bureau
925 Section 501 (c)(1) with 50%
deductibility
926 Government instrumentality other
than section 501 (c)
927 Fundraising
928 4947(a)(2) trust
931 Withdrawal liability payment fund
990 Section 501 (k) child care organization
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Soperfcmd
Technical
Assistance
Grant (TAG)
Handbook:
Applying
for Your
Grant
September 1998 -TOQl G1-
-------
-TOOIG2-
-------
United States EPA 540-K-93-003
Environmental Protection Publication 9230.1-09A
Agency PB93-963352
September 1993
Office of Solid Waste and Emergency Response
&EPA Superfund Technical
Assistance Grant (TAG)
Handbook:
Applying For Your
Grant
-------
EPA CONTACTS
For more information about the Technical Assistance Grant
(TAG) Program, contact:
Regional TAG Coordinator:
Community Involvement Coordinator:
National TAG Coordinator
U.S. Environmental Protection Agency (5204G)
401 M Street, SW
Washington, DC 20460
(703) 603-8889
-------
CONTENTS
BASIC REQUIREMENTS 1
The TAG Program 1
The Superfund Cleanup Process 1
Beginning the Process 2
Making Sure Your Group Is Eligible 3
Demonstrating Your Group's Capabilities 4
Meeting Your Financial Requirements 4
Identifying Eligible Activities 6
The TAG Application 8
Intergovernmental Review 10
Submitting Your Grant Application 10
EPA Evaluation of the Grant Application 11
EPA Notification of Grant Applicants 11
Accepting a Grant Agreement 12
TAG APPLICATION CHECKLIST 11
GLOSSARY... ...15
111
-------
IV
-------
BASIC REQUIREMENTS FOR APPLYING FORA
TECHNICAL ASSISTANCE GRANT
THE TAG PROGRAM ^^^^^^^^^^^^^^^^
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.
THE SUPERFUND CLEANUP 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
Milestones in the
Superfund Process
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 is
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 resi-
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 LOT stating this. If you have not sent in
an LOT, 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).
MAKING SURE YOUR GROUP IS ELIGIBLE ^^^^^^^^
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
Your group is
INELIGIBLE for a TAG
if it is:
Potentially responsible
for contamination prob-
lems at the site.
An academic institution.
A political 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.
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-
strate that your group has established, or
EPA will evaluate
your group's
ability to:
Meet project
deadlines.
Maintain adequate
accounting and au-
diting procedures.
Raise
contributions.
Comply with civil
rights and equal
employment laws.
has plans for establishing, reliable proce-
dures for managing a TAG.
MEETING YOUR FINANCIAL
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,
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. _. , ,,
The full match would be
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:
an unusual financial
hardship (demonstrated
by conditions such as be-
low-average income or a
high unemployment rate
in your area).
Your group's good faith
effort at raising the match
or in-kind contributions
has failed.
The waiver is necessary
to ensure public partici-
pation in the site 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 carried 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 provide
direction and oversight of contrac-
tors' 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.
Participating in site visits to
gain a better understanding
of cleanup activities.
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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Exhibit
Tasks for Which a Technical Advisor 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 (RI/FS), to explain what
is known about the nature of the problems at the site based on the
PA/SI data.
Reviewing selected technical documents, including the RI/FS
report, produced during the RI/FS.
Participating in public meetings to help clarify information about
site conditions and how the RI/FS will address these conditions.
Interpreting results of the RI/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 RI/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 priorto 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."
Suitable grant
administrator
activities include:
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.
Tracking expenses.
Submitting payment
vouchers.
Taking meeting notes.
Acting as the group
contact with the EPA
Regional Office.
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).
THE TAG APPLICATION ^^^^^^^^^^^^^^^
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.
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:
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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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INTERGOVERNMENTAL REVIEW ^^^^^^^^^^^^^
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 follow. 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.
Determining state
requirements should
be one of the first
things you do in
preparing your
application.
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.
SUBMITTING YOUR GRANT APPLICATION
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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EPA EVALUATION OF THE GRANT APPLICATION ^^^^^
To ensure that grants are awarded to the applicants most directly 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 that 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.
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.
When you receive
your grant, note
carefully the:
Dollar amount
awarded.
Project period shown
on the first page.
Approved budget.
Non-federal percent-
age shown.
Special conditions
that may be included.
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.
12
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TAG APPLICATION CHECKLIST
a Submit a Letter of Intent (LOI).
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 form, "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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NOTES
14
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GLOSSARY
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 in-
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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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.
Debarment:
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 offi-
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.
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 CFR 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 used 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 individual(s) 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.
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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.
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 PRPs 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 i
18
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Technical
Oatreach
Services for ^J
Communities
September 1998 -TflOl HI-
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-TOOIH2-
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REGIONAL
CONTACTS
Northeast HSRC
Bill Librizzi
New Jersey Institute of Technology
Otto H. York CEES
138 Warren St.
Newark, NJ 07102
Phone: (201) 596-5846
Great Plains/Rocky
Mountains HSRC
Pat McDonald
Kansas State University
101 Ward Hall
Manhattan, KS 66506
Phone: (913) 532-7496
Great Lakes/Mid-Atlantic HSRC
KirkRiley
A-124 Research Complex-Engineering
Michigan State University
East Lansing, MI 48 824
Phone: (517) 355-7493
South/Southwest HSRC
John Nemeth
Environmental Science and Technology Program
Georgia Tech Research Institute
229 Baker Building
Atlanta, GA 30332
Phone: (404) 894-7428
Western Region HSRC
Ken Williamson
Oregon State University
210 Strand Agriculture Hall
Corvallis,OR97331-2302
Phone: (541) 737-6836
OUTREACH
SERVICES FOR COMMUNITIES
A service of the
University-based
Hazardous Substance
Research Centers
Program
NX
Providing
independent
scientific and
technical assistance
to communities
dealing with
hazardous
substance
contamination
questions.
J/
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Who Are We?
The TOSC program is supported by the five Haz-
ardous Substance Research Centers. Our centers
are represented by experts in the fields of environ-
mental science and engineering from twenty-
nine of the nations leading research universities.
Collectively our centers service all of the
United States and Puerto Rico. Our research
develops new treatment methods for hazardous
substances that threaten groundwater and environ-
mental quality.
Through the TOSC program, we provide technical
assistance to communities impacted by
hazardous waste sites.
What Can
We Do?
Answer questions about potential
health effects and possible cleanup
technologies for hazardous waste
sites.
Types of
Services
Assist your community to become
active participants in the decision-
making process involved in cleaning
up hazardous environments.
Hold community workshops and
provide educational material regard-
ing human health, environmental
risks, and regulatory concerns.
Help your community to better
understand what clean-up options
are available and their potential
effectiveness.
TOSC provides your community the services you
need to increase your involvement in the
decision making process.
Review of Technical Materials
Reviewing and interpreting technical documents
and other material relating to hazardous
substances is a primary duty of TOSC.
Education
TOSC often offers seminars, courses,
role-playing, and coaching workshops in order
to educate communities on environmental
science and policy issues.
Community Organization
Enhancement
TOSC has been instrumental in strengthening
community groups by training community
leaders and facilitating meetings.
Technical Assistance Tools
TOSC has created educational and assistance
materials which are useful to community groups
fraught with complicated cleanup issues.
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