c/EPA
United States
Environmental Protection
Agency
Solid Waste and
Emergency Response
(OS-210)
EPA 540/G-88/001
April1990
Superfund Technical
Assistance Grant (TAG)
Handbook
Parti
Applying for Your
Technical Asistance
Grant
U.S. Environmental Protection Agency
Region 5, Library (PL-]?j)
77 West Jacksun bo..'^;^ i^.i rioor
Chicago, IL 60604-3590
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Superfund Technical
Assistance Grant
(TAG) Handbook
April 1990
(OSWER Directive 9230.1-03)
Printed on Recycled Paper
Alt White Paper Stocks Contained
In This Publication Contain Recycled Fibers
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Preface
This handbook is designed to guide you through the entire Technical Assistance
Grant (TAG) Program, from applying for the grant to selecting a technical advisor
and managing your TAG project. The handbook explains federal policies,
procedures, and regulations related to the TAG Program and provides detailed
instructions on how to complete necessary grant forms.
You must begin by filing a Letter of Intent prior to applying for a TAG to notify the
U.S. Environmental Protection Agency (EPA) of your interest in a grant and give
other interested groups an opportunity to join with you in applying or to apply
separately. You will find a sample Letter of Intent on page 1 -37. This handbook
is intended for those who have already submitted a Letter of Intent. If you have
not done so, contact your EPA Regional Office for more information about this step.
(Use the map in the accompanying pamphlet entitled "EPA Superfund Technical
Assistance Grants" to determine the EPA Regional Office for your state.)
The handbook consists of three parts. Part 1 provides detailed guidance
on applying for a TAG; Part 2 explains the process of selecting a
technical advisor; and Part 3 contains comprehensive information on
managing a TAG. Each of these parts can serve as a "stand-alone"
booklet that addresses a particular, chronological step in the TAG
Program.
In an effort to meet the needs of those affected by Superfund sites, the EPA
Regional Offices have designed citizen outreach programs to assist groups of
affected individuals interested in obtaining TAGs. Your EPA Regional Office is
ready to answer any questions you may have by telephone or meet with you in
person to provide as much help as possible. Although this process can be lengthy
and does require a significant commitment from you, EPA believes that this is an
extremely valuable program. You may want to talk with current TAG recipients as
you are deciding whether you should apply. Your Regional Office should be able
to provide contact names. (Telephone numbers and addresses of TAG
Coordinators in the EPA Regional Offices can be found in the "References" section
at the back of this handbook.)
April 1990
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II Preface
Each of the three parts of this handbook contains all of the materials you need to
complete the step that is being explained (including text, instructions for filling out
the forms, key "do's and don'ts," commonly asked questions, sample completed
forms, a checklist for review, and blank forms you will need to complete that step
of the TAG Program). You should read all three parts before applying for the grant
to help you understand everything that is involved in the process.
Also, because federal grant and procurement regulations govern the way in which
EPA can award grants, grant applicants are encouraged to read the applicable
regulations carefully. This handbook is provided to help you understand these
regulations, but the regulations ultimately dictate how the TAG Program operates.
Excerpts of relevant rules and regulations have been provided at the back of this
handbook for your reference. The full texts of these regulations are available from
EPA upon request, but also should be available at your local library.
Readers who would like to comment on the usefulness and clarity of this handbook
are encouraged to send their comments to their EPA Regional TAG Coordinator or
to:
TAG Coordinator
Mail Code OS-220
Office of Emergency and Remedial Response
U.S. Environmental Protection Agency
401 M Street, S.W.
Washington, D.C. 20460
April 1990
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Superfund Technical Assistance Grant (TAG) Handbook
Table of Contents
Preface i
Introduction v
Part 1: Applying For Your Technical Assistance Grant 1-1
Introduction 1-1
Basic Requirements For Applying For A
Technical Assistance Grant 1-5
Step-by-Step Application Instructions 1-15
Do's and Don'ts In Applying For A Technical Assistance Grant 1-31
Commonly Asked Questions About Applying For A
Technical Assistance Grant 1-33
Sample Application Documents 1-35
TAG Application Checklist 1-71
Blank Application Documents 1-73
Part 2: Selecting Your Technical Advisor(s) 2-1
Introduction 2-1
Basic Requirements For Selecting Your Technical Advisor(s) 2-5
Step-by-Step Instructions For Selecting Technical Advisors 2-13
Do's and Don'ts In Selecting Technical Advisors 2-27
Commonly Asked Questions About Selecting Technical Advisors 2-29
Sample Documents For Selecting Technical Advisors 2-33
Checklist For Selecting Technical Advisors 2-57
Blank Documents Needed For Selecting Your Technical Advisor 2-61
Part 3: Managing Your Technical Assistance Grant 3-1
Introduction 3-1
Basic Requirements For Managing Your Technical Assistance Grant 3-5
Step-by-Step Instructions For Completing Grant Management Documents .... 3-13
Do's and Don'ts in Managing Technical Assistance Grants 3-31
Commonly Asked Questions About Managing Technical Assistance Grants . . . 3-33
Sample Grant Management Documents 3-35
Checklist of Steps to Take in Managing Technical Assistance Grants 3-65
Blank Documents You Will Need To Manage Your Technical
Assistance Grant 3-67
References R-1
Glossary R-3
Key Contacts List R-11
Technical Assistance Grant Regulations R-29
Index 1-1
April 1990
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Introduction
If you are a member of a group of individuals affected by a Superfund site -
whether for economic, environmental, or health-related reasons - your group may
be eligible to apply for a Technical Assistance Grant (TAG). The U.S. Environmental
Protection Agency (EPA) is able to award up to $50,000 per site to an affected
group of individuals to help the group obtain independent interpretations of site
cleanup reports and studies. (Exhibit 1.A. on page 1-9 lists tasks for which a
technical advisor may be useful.) The site must be on the National Priorities List
(NPL) or proposed for listing, and EPA must have begun its response action at the
site. The NPL is EPA's list of the most serious hazardous waste sites identified for
possible long-term cleanup. This handbook explains how to apply for a TAG, select
a technical advisor, and manage the grant.
Superfund and the Technical Assistance Grant Program
The Comprehensive Environmental Response, Compensation, and Liability Act of
1980 (CERCLA), commonly known as "Superfund," provides the nation with its
principal means of cleaning up hazardous waste sites that EPA has placed, or
proposed to place, on the NPL In cleaning up a Superfund site, EPA must conduct
detailed technical studies of the nature and extent of the waste at the site, evaluate
the methods available for cleaning up the contamination present, and design and
implement the cleanup itself. (In some cases, a state or the party responsible for
the contamination takes the lead in cleaning up the site under EPA supervision.)
Upon identification of a potentially-contaminated site, EPA determines whether the
site poses an immediate threat to human health and 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 Assessment/
Site Inspection to determine whether the site should be placed on the NPL - the
list of the nation's most serious hazardous waste sites.
Once a site is listed, EPA examines the type and extent of contamination present
at the site and identifies possible remedies through a Remedial Investiga-
tion/Feasibility Study. This study outlines alternative methods of cleanup available
and recommends the one most suitable. The Record of Decision (ROD) identifies
and explains the remedy selected.
April 1990
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VI Introduction
After signing a ROD, EPA undertakes the Remedial Design phase, adapting the
type of remedy chosen to site-specific conditions. Remedial Action is the phase
in which EPA actually cleans up the site using the selected remedy. There typically
continue to be Operation and Maintenance activities at the site for many years
after the cleanup is completed.
For More Information On The Superfund Program
For more about the cleanup process for Superfund sites, see the
pamphlet and fact sheet accompanying this handbook: "The New
Superfund: What It Is, How It Works," and "Summary of Public Docu-
ments Prepared During the Remedial Process." Your EPA Regional
Office can also provide additional information.
To help ensure that affected individuals are well informed about the conditions
and activities at Superfund sites in their communities, Congress included the TAG
Program in the 1986 amendments to the Superfund law. The TAG Program
provides groups of individuals affected by such sites with grants to hire in-
dependent technical advisors who can help them understand technical information
related to cleaning up these sites. One grant is available per site as long as the
site is listed, or proposed for listing, on the NPL and EPA has begun its response
action at the site.
While a Technical Assistance Grant provides communities with some of the
resources necessary to hire technical advisors, obtaining these resources is only
the first step in the TAG Program. It is up to grant recipients to define the most
effective role for their technical advisors within the scope of federal grant regula-
tions. Because site conditions can vary widely, recipients should carefully consider
site-specific circumstances in deciding what kind of help they need and in
determining how best to use their technical advisors. The EPA Regional Remedial
Project Manager for the site is a good source of information about site-specific
conditions. Your Regional TAG contact (see the "References" section of this
handbook) can put you in touch with the Remedial Project Manager.
Key Elements of the TAG Program
This section provides a general description of the TAG Program. The rest of the
handbook expands on this information as it guides you through the steps of
obtaining and using a TAG. You should also read the regulations in the
"References" section of this handbook and consult your EPA Regional Office if
anything is unclear.
April 1990
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Introduction VII
LETTER OF INTENT: The TAG process begins when a group of individuals affected
by a Superfund site on the NPL (or proposed for listing on the NPL) submits a
Letter of Intent to their EPA Regional Office. Such a letter notifies EPA of the
group's interest in applying for a TAG. EPA then notifies the community as a
whole that a grant for the site may soon be awarded, giving other potential
applicants 30 days to contact the original applicant to form a coalition and submit
a single application. If the groups are unsuccessful in forming a coalition, they
then would have an additional 30 days to prepare separate applications. This
handbook is designed to be read after you have submitted a Letter of Intent.
EPA encourages affected groups to consolidate because there is only one grant
available per site, and EPA would prefer to provide technical assistance to the
most widely representative group of individuals affected by a site. If the groups
cannot form a single coalition, they should notify EPA immediately. If EPA receives
more than one application for the site, EPA may ask each applicant for additional
information beyond what is in the initial application to help EPA choose the most
appropriate recipient.
GRANT APPLICATION: Applicants must submit a completed grant application, a
procurement system certification form, and a debarment certification form to the
appropriate EPA Regional Office. The grant application describes applicant
qualifications, the projected tasks, and the schedule and budget for technical
assistance activities. In the budget, applicants must demonstrate that they are
able to provide 20 percent of the total project costs, either in in-kind services, such
as volunteer labor (see Part 1 of this handbook), or in cash. By completing the
procurement system certification form, the applicant agrees to comply with relevant
federal government procedures for selecting technical advisors (described in Part
2 of this handbook). The debarment certification form represents your group's
assurance that your group and its officers have not been disqualified from
participating in federal transactions. Before submitting a TAG application to EPA,
applicants must contact their designated state office (see the "References" section)
to determine what, if any, steps they must take to comply with their state's inter-
governmental review process.
Once you submit your application to EPA, the length of time EPA will require to
review it will vary. EPA will notify each applicant group in writing as to whether its
grant request has been accepted or disapproved. Part 1 of this handbook
describes the application process in more detail.
April 1990
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VI il Introduction
SELECTING YOUR TECHNICAL ADVISOR: There are three basic methods of selecting
a technical advisor if you receive a TAG. You may use the small purchase method
if the contract with the advisor is for $25,000 or less. For contracts involving more
than $25,000, competitive selection is the appropriate procedure. Noncompetitive
selection can be used if there is only one qualified candidate for the position, but
noncompetitive contacts over $10,000 must be approved in advance by the EPA
Award Official.
Many TAG recipients will use the competitive selection procedures. This approach
requires recipients to maximize free and open competition for the contract(s).
Typically, TAG recipients will publicize their need for assistance in a local
newspaper, providing about 30 days for responses before the deadline for receipt
of proposals. Those who inquire about your announcement should be given a
solicitation. Your solicitation should describe the services you need and state the
criteria by which you will evaluate proposals. You must then conduct a cost
analysis for each proposal received, basing your selection on the criteria identified
in your solicitation.
Once you select a technical advisor, you must develop a contract with the
technical advisor. The contract must include the following elements: the nature,
scope, and extent of work to be performed; the time-frame for the project; the total
cost of the work to be performed; payment provisions; and model clauses.
Procedures for selecting technical advisors are discussed more fully in Part 2 of
this handbook, which also contains a sample contract.
MANAGING YOUR GRANT To ensure that federal funds are managed responsibly,
you must comply with certain recordkeeping and reporting requirements. These
are discussed in detail in Part 3 of this handbook. Where grant-related forms call
for standard information, EPA has filled in the information for you to simplify your
paperwork.
You should, however, anticipate that some steps in the TAG application process
will be more time-consuming than others. Your group may wish to identify and
initiate these activities well in advance of required deadlines. Some of the more
time-consuming steps in the process include: consolidating with other groups who
may also be interested in applying for the single TAG available for the site in your
community; identifying and securing in-kind services and/or funds for the matching
contribution to total project costs; identifying potential technical advisors;
developing budget tracking procedures; and setting up recordkeeping systems.
Your EPA Regional Office will help you wherever possible.
April 1990
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Introduction IX
Information On The TAG Program
You will find a detailed description of the TAG Program in a fact sheet
entitled "EPA Superfund Technical Assistance Grants" accompanying this
handbook.
Remember, before you fill out the TAG application, you must send a Letter of Intent
to your EPA Regional Office. To determine which EPA Region you are in and the
address of your EPA Regional Office, consult the "References" section at the end
of this handbook. You are encouraged to telephone that office to discuss any
questions you may have about the TAG Program and, more specifically, the
application process. If your application is successful, your grant will be overseen
by your EPA Regional Office. Therefore, you should work closely with that office
in preparing your application.
April 1990
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Superfund Technical
Assistance Grant (TAG)
Handbook
Part 1
Applying for Your
Technical Assistance
Grant
April 1990
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1-1
Introduction
If you are a member of a group of individuals affected by a Superfund site, your
group may be eligible to apply for a Superfund Technical Assistance Grant (TAG).
TAG funds enable groups of individuals affected by Superfund sites to select
independent advisors to help interpret technical information related to the cleanup
of sites in their communities.
Part 1 is the first of three "stand-alone" booklets in the Superfund Technical
Assistance Grant (TAG) Handbook. Each booklet describes a different phase of
the TAG Program. Part 1 explains how your group can apply for a TAG. Part 2
explains how to select a technical advisor if you receive a grant, and Part 3 provides
grant management guidelines.
Each of the three major parts of this handbook contains all the information you will
need to complete the phase of the TAG Program it addresses. Each part begins
with its own table of contents showing the topics covered. Then you will find an
explanation of the basic requirements of the U.S. Environmental Protection Agency
(EPA) pertaining to the particular phase of the TAG Program discussed (such as
the application phase for Part 1). You will find step-by-step instructions for
completing documents and activities required in that phase of the Program, followed
by key "do's and don'ts" to keep in mind as you carry out these instructions, as
well as commonly asked questions. Sample completed documents needed for the
phase are included to illustrate the type of information EPA seeks. A checklist of
steps involved in meeting the requirements for the phase provides a review of
material covered, and each part concludes with a set of blank documents your
group can use to comply with federal requirements for that phase of the TAG
Program.
Towards the end of the handbook, you will find a "References" section that includes
a glossary, list of key contacts, and excerpts of the regulations applicable to the
TAG Program. The final section of the handbook is an "Index" to assist you in
locating key words and topics throughout the three parts.
Throughout the process of applying for a TAG, selecting a technical advisor, and
managing your Technical Assistance Grant project, it will be to your advantage to
work closely with your EPA Regional Office, since that office will oversee your
project. Asking questions is likely to improve, rather than hurt, your chances of
receiving the grant.
April 1990
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1-3
Part 1
Table of Contents
Introduction 1-1
Basic Requirements For Applying For A Technical Assistance Grant 1-5
Before You Go On: A Pre-Application Checklist 1-5
Making Sure Your Group Is Eligible 1-6
Demonstrating Group Responsibility 1-6
Meeting Financial Requirements 1-6
Incorporating 1-8
Identifying Eligible Activities 1-8
The Application 1-10
Intergovernmental Review 1-11
Submitting Your Grant Application 1-12
Evaluating The Grant Application 1-12
Notifying Grant Applicants 1-13
Accepting A Grant Agreement 1-13
Step-by-Step Application Instructions 1-15
Do's and Don'ts In Applying For A Technical Assistance Grant 1-31
Commonly Asked Questions About Applying For A Technical Assistance Grant 1-33
Sample Application Documents 1-35
TAG Application Checklist 1-71
Blank Application Documents 1-73
April 1990
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1*4
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Basic Requirements For
Applying For A Technical
Assistance Grant
1-5
This section of Part 1 explains the basic TAG
Program requirements that your group must
meet to be eligible for a TAG and to success-
fully complete a TAG application. The ap-
plication process is governed by grant and
procurement (or selection) requirements in the
Code of Federal Regulations (Parts 30, 33,
and 35 Subpart M of Volume 40) and in
Circular A-122, published by the U.S. Office
of Management and Budget (OMB). It is
important that you clearly understand these
requirements and how they apply to the TAG
Program. Relevant excerpts of these pro-
visions, contained in the "References" section
at the back of this handbook, are para-
phrased in Part 1 below. If you wish, you
may obtain the full text of the regulations from
your EPA Regional Office or your library.
(The "References" section also contains a list
of EPA Regional contacts' addresses and
telephone numbers.)
Before You Go On:
A Pre-Application Checklist
This handbook is intended for groups of
affected individuals who have already decided
to apply for a TAG and have sent EPA a
Letter of Intent stating this. To make the best
use of your time, you should be able to
answer "yes" to all of the following questions
before beginning the application process
described in Part 1.
Q Is the site that you are concerned about
listed, or proposed for listing, on the
National Priorities List under the
National Contingency Plan (NCP)?
Q Has EPA's response action begun at
the site?
Q Have you contacted your EPA Regional
Office for Region-specific TAG instruc-
tions?
Q Have you filed a Letter of Intent with
EPA?
a Are you a group of residents who are
affected by the site? (NOTE:
Academic institutions; political sub-
divisions established or sustained by a
governmental entity; and/or an individual
Potentially Responsible Party (PRP) or
a group affiliated with a PRP are not
eligible for TAG funds.)
If you answered "no" to any of the above
questions, or are unsure, you should contact
your EPA Regional Office before proceeding.
If you answered "yes" to all of the above
questions, read on to find out how to apply
for your Technical Assistance Grant.
April 1990
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I "6 Basic Application Requirements
Making Sure Your Group
Is Eligible
Your group is eligible to receive a TAG if you
are a group of individuals affected by a
hazardous waste site that is: (1) listed on the
National Priorities List (NPL); or (2) proposed
for listing. In addition, EPA must have started
its response action at the site. The response
action begins when EPA sets aside funds for
site cleanup. Your EPA Regional Office can
tell you whether the response action has
begun.
Finally, your group must be incorporated.
Ordinarily, you must be incorporated for the
specific purpose of addressing the Superfund
site for which the grant would be provided.
However, your group may be incorporated for
a broader purpose if it has developed a
substantial history of involvement at the site.
If your group would be eligible except that it
is not incorporated and does not have a
substantial history of involvement at the site,
you may submit an application as long as
you will incorporate by the time you submit
your first request for reimbursement. Be sure
to state in your application that this is what
your group plans to do.
You are ineligible for a TAG if you are:
• An individual or company potentially
responsible for the contamination
problems at the site;
• An academic institution;
• A political subdivision (such as a town-
ship or municipality); or
• A group established and/or sustained
by governmental entities or by any other
ineligible entity (including emergency
planning committees and some citizen
advisory groups).
While individuals functioning as representa-
tives of ineligible groups cannot be members
of eligible groups, individuals who act solely
in the capacity of "affected individuals" are
eligible. 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 were affected by the site. Contact
your EPA Regional Office for assistance in
determining your group's eligibility.
Demonstrating Group
Responsibility
As a TAG applicant, your group must demon-
strate its ability to adequately manage the
grant. EPA will evaluate your group's ability
to: meet project deadlines; maintain ade-
quate accounting and auditing procedures;
raise in-kind contributions; and comply with
civil rights and equal employment laws. In
general, you must demonstrate that your
group has established, or has plans for
establishing, reliable procedures for record-
keeping and maintaining financial
accountability in managing a TAG. (See
Part 3 for a discussion of the management of
grant funds.)
Meeting Financial Requirements
As specified in the 1986 amendments to the
Superfund law, initial TAG awards are limited
to $50,000 for a single site. In addition, these
amendments require recipient groups to
April 1990
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Basic Application Requirements
1-7
contribute 20 percent of the total project
costs, although this contribution need not be
cash. However, it is possible to request a
deviation from the grant ceiling and a waiver
of the match requirement. These require-
ments are discussed in more detail below.
DEVIATION FROM THE $50,000 GRANT Liiim
EPA will make initial awards of no more than
$50,000 to groups of affected individuals.
However, to address sites that are so com-
plex that a grant of $50,000 will be inade-
quate, EPA will consider requests for addi-
tional funds once the initial award has been
made, provided that the site has been listed
on the NPL (See Part 3 for more details.)
TWENTY PERCENT MATCHING FUNDS REQUIRE-
MENT: In order for your group to be awarded
a TAG, 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's skills and time, the TAG Pro-
gram allows you to count the value of volun-
teer services and contributions of supplies
toward the required match. Volunteer ser-
vices and donated supplies used toward your
match are called "in-kind contributions."
IN-KIND CONTRIBUTIONS: In-kind contributions
are non-cash contributions to the grant and
can be included as part of your 20 percent
match. In-kind contributions include:
• Volunteer services, such as accounting
and editing;
• Equipment (such as a word processor
or copier) and use of office space;
• Supplies (such as paper and pencils);
• Photocopying, printing, and postage;
• Telephone calls;
• Incorporation filing fees; and
• Other costs that are approved by EPA
in your TAG application and that are
related to the grant (such as telephone
calls, postage, and copying).
All in-kind contributions must be documented
in your records and approved by your EPA
Regional Office. Rates for volunteer services
must be consistent with rates in your com-
munity for similar services. Rates must not
include fringe benefits, overhead, or profit.
Volunteers must maintain timesheets in order
to claim their services as in-kind contributions.
Your EPA Regional Office will be happy to
assist you in determining your in-kind con-
tributions.
WAIVERS OF THE MATCHING FUNDS REQUIRE-
MENT: Because in-kind contributions can be
counted toward your group's 20 percent
match, EPA will waive the matching funds
requirement only under unusual circumstan-
ces. EPA can grant waivers, however, only
at sites where the Record of Decision (ROD)
has not yet been signed for the last operable
unit at the site. To obtain a waiver of the
match, your group can demonstrate that: (1)
your group needs a waiver because providing
the full match would constitute an unusual
financial hardship as demonstrated by such
measures as below average per capita in-
come, below average median household
income, or a high unemployment rate in your
area; and (2) that your group's good faith
April 1990
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1 "8 Basic Application Requirements
effort at raising the match or obtaining in-kind
services has failed.
Therefore, activities suitable for technical
advisors include:
Incorporating
To receive a grant, you should be incorpor-
ated as a non-profit organization for the
purpose of addressing the Superfund site for
which the grant is provided. If your group is
incorporated for some other purpose and has
a substantial history of involvement at the
site, you also may be eligible. Incorporation
can protect the individual members of your
group from potentially serious personal
liability problems that could result if the grant
were awarded to an unincorporated group or
organization. Many groups find it desirable
to also apply for tax-exempt status at the
same time that they incorporate. When you
have tax-exempt status, individuals can make
tax-deductible cash donations to your group.
The costs of incorporating can be paid for
with TAG funds if you receive a grant. Your
EPA Regional Office can give you more
information about incorporating and applying
for tax-exempt status.
Identifying Eligible Activities
This section describes activities that can and
cannot be carried out with TAG funds.
Questions concerning activities suitable for
technical assistance should be directed to the
appropriate EPA Regional contact.
ELIGIBLE ACTIVITIES: The purpose of the grant
is to assist affected 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 activities.
• Reviewing and interpreting site-related
documents;
• Meeting with the recipient group to
explain technical information;
• Providing assistance to the recipient
group in communicating the group's
site-related concerns to EPA;
• Communicating the contents of the
technical advisor's reports to the com-
munity;
• Participating in site visits, when pos-
sible, to gain a better understanding of
cleanup activities; and
• Traveling to meetings, hearings, etc.,
directly related to the situation at the
site.
Exhibit 1.A. suggests a number of points in
the cleanup process when your technical
advisor(s)' involvement may be particularly
useful. When you fill out the grant applica-
tion, you will be asked to estimate the
amount of review time necessary for your
technical advisor(s). You are encouraged to
discuss with your EPA Regional Office
projected tasks for your advisor and how
these tasks may be affected by site-specific
circumstances.
INELIGIBLE ACTIVITIES: Grant funds may not be
used to finance the following activities:
• Political and lobbying activities;
• Any activities or expenses related to
travel by members of your group;
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Basic Application Requirements
1-9
Exhibit 1 .A.
TASKS FOR WHICH A TECHNICAL ADVISOR MAY BE USEFUL
Reviewing public documents generated during the removal process.
Reviewing Preliminary Assessment/Site Investigation (PA/SI) data that led to the
site's listing.
Participating in informal meetings with your group prior to the Remedial Investiga-
tion/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 during the RI/FS 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 available for public review. If the
RI/FS report discusses possible remedial alternatives, explaining the range of
alternatives under consideration. Identifing 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
presented in the proposed plan for the site.
Explaining the lead and supporting agencies' remedial action decision presented
in the Record of Decision for the site.
Reviewing the remedial design (RD) to ensure that your group's concerns are
addressed.
During remedial action (RA), visiting the site vicinity periodically to observe the
progress of construction activities and to provide a technical update to your
group's members.
Reviewing the final inspection/certification report and final technical report because
any concerns over construction activities must be raised prior to EPA's acceptance
of the completed project.
April 1990
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1-10 Basic Application Requirements
• 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 re-
opened such a decision for comment;
and
• Financing, directly or indirectly, an
attempt to influence the outcome of an
election, any voter participation or
registration activity, or any partisan or
non-partisan political activity.
Although the above activities cannot be
funded with TAG monies, members of a
recipient group may be able to undertake
them by using other funds (so long as those
funds are not used to meet the 20 percent
match requirement).
The Application
The following discussion provides a basic
orientation to the structure, organization, and
timing of the application. In addition, it
suggests steps to take before filling out the
application.
OVERVIEW OF THE APPLICATION FORMS: The
federal grant application form EPA is required
to use for the TAG Program is entitled, "State
and Local Nonconstruction Programs" (EPA
Form 5700-33). As the name implies, it is a
grant application form used for many other
grant programs besides the TAG Program.
The basic application form consists of five
parts:
I. General Information, Signature, and
Certification;
II. Project Approval Information;
III. Budget Information;
IV. Project Narrative Statement (Applicant
Qualifications and the Statement of
Work); and
V. Assurances.
In addition, you must complete a Procurement
Certification Form (EPA Form 5700-48) and,
if your group seeks a grant of $25,000 or
more, a form entitled "Certification Regarding
Debarment, Suspension, and Other Respon-
sibility Matters" [EPA Form 5700-49 (11-88)].
On the Procurement Certification Form you
will need to indicate that your group has a
procurement system in place that conforms
to federal regulations (which is very unlikely)
or that you will allow EPA to review your
selection process before signing a contract
with a technical advisor. The "Certification
Regarding Debarment, Supervision, and Other
Responsibility Matters" represents your
group's assurance that it has not been dis-
qualified from engaging in transactions with
the federal government.
To aid you in completing your grant applica-
tion, detailed step-by-step instructions specific
to the TAG Program are provided beginning
on page 1-15. To illustrate these instruc-
tions, Part 1 also contains a sample version
of the application. The information that
appears in the completed forms represents
data from a fictitious applicant group and is
provided solely as an example of a properly
completed form. If you have questions on
the TAG Program requirements or how to
complete the forms, contact your EPA
Regional Office and you will be put in touch
with the person who can best answer your
question. In addition, your EPA Regional
-------
Basic Application Requirements !-11
TAG staff is available to meet with you to help
you complete the grant application.
CONSOLIDATING: If you are aware of other
groups in your community who plan to apply
for a TAG at the same site your group is
concerned about, you are strongly encour-
aged to consolidate your applications into
one. Only one TAG is available at each
Superfund site. If there is more than one
qualified applicant and the groups cannot
consolidate, EPA will award the grant to the
single most appropriate applicant based on
EPA's evaluation of each application. If EPA
must review competing applications, the
process will, by necessity, require more time
and the award of a grant may be delayed.
Meanwhile, cleanup at the site will continue,
meaning that the recipient's technical ad-
visor(s) will come into the process later than
would be the case if there were only one TAG
applicant. Therefore, everyone benefits if
groups form a coalition in a timely fashion.
PLANNING AND SCHEDULING ACTIVITIES: Typical-
ly, a TAG is awarded for a three-year budget
period. However, the cleanup process at
Superfund sites generally takes from three to
seven years. Therefore, you may want to
plan your expenditures in such a way that
you have funds left at the end of the first
budget period; these funds can be carried
over into a second budget period so that
your group has access to a technical advisor
throughout the cleanup process. To do this,
you will need to submit a continuation ap-
plication to EPA prior to the expiration of the
initial budget period. Directions for complet-
ing a continuation application can be found
in Part 3. If your group wishes to use a
budget period of other than three years,
contact your EPA Regional Office.
GETTING READY: Before filling out a TAG
application, you should contact the EPA
Remedial Project Manager for the site to
obtain information about the planned
schedule for site activities. This information
will help you plan the activities you would like
to have your technical advisor(s) perform.
Keep in mind, however, that site activity
schedules are subject to change.
Intergovernmental Review
All grants are subject to intergovernmental
review. This means that you must provide
your state an opportunity to review your grant
application so that your Governor can stay
informed about the variety of grants awarded
to groups within your state. State require-
ments regarding intergovernmental review
vary. You should, therefore, call your state's
contact person for intergovernmental review
to find out what procedures to follow. You
will find a state-by-state list of intergovern-
mental review contacts in the "References"
section of this handbook. Typically, you will
need to submit a copy of your grant applica-
tion to a single point of 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.
States may require a maximum of 60 days for
the intergovernmental review process. EPA
cannot process your application package
without evidence that your state has
completed its intergovernmental review, as
indicated in Item 22 (Part I, Section II) of your
application form. Therefore, determining your
state's requirements should be one of the first
things you do in preparing your TAG
application.
April 1990
-------
I "12 Basic Application Requirements
Submitting Your Grant Application
Completed grant application packages must
be submitted to the EPA Regional Office
overseeing cleanup activities at your site.
You must submit the original application
package and two copies. The primary ap-
plication must have the original signature of
your group's project manager. Your project
manager is 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
adequately demonstrate that you have com-
plied with the regulations governing the TAG
Program.
You should be aware that, in general, the
information supplied by groups is not con-
sidered confidential. When EPA receives a
grant application, the information you supply
becomes part of EPA's records and is there-
fore subject to public release under the
Freedom of Information Act (5 U.S.C. 552).
Evaluating The Grant Application
To ensure that grants are awarded to the
applicants most directly affected by the site,
EPA developed a process to evaluate the
strengths and weaknesses of each applica-
tion. EPA will review and score all applica-
tions using the five evaluation criteria outlined
below. The "Instructions" section of Part 1
tells you how to demonstrate that your group
meets these criteria (see page 1-15). The
five criteria that will be used to evaluate your
application include:
1. The presence of an actual or potential
health threat posed to group members
by the site. (30 points)
2. The applicant best representing groups
and individuals affected by the site. (20
points)
3. The applicant's plans to use the
services of a technical advisor
throughout the Superfund response
action, which includes all activities from
preliminary planning and investigation
through operation and maintenance.
(20 points)
4. The demonstrated intention and ability
of the applicant to share with others in
the community the information provided
by the technical advisor(s). (20 points)
5. The presence of an actual or potential
economic threat or threat of impaired
use or enjoyment of the environment to
group members that is caused by the
site. (10 points)
Because only one grant may be awarded for
any eligible site, EPA will rank each applica-
tion against any other applications for the
same site. In completing your TAG applica-
tion, you need only supply a paragraph to
address each of the above criteria. If EPA
receives competing applications for one site,
EPA may contact you for additional informa-
tion to help EPA make the best choice.
-------
Basic Application Requirements 1 •! 3
Notifying Grant Applicants
The length of time required for EPA to review
your application once the intergovernmental
review process has been completed will vary.
When EPA has reviewed your completed
application, EPA will send you a written notice
telling you whether your grant request has
been approved. If the grant has been
approved, EPA's Award Official will prepare
and sign a grant agreement, which your
group's project manager also must sign. The
Award Official is the EPA official (usually the
Regional Administrator) delegated the author-
ity to sign grant agreements.
The grant agreement specifies budget and
project periods, the federal share of project
costs, the matching funds that your group will
contribute, a description of the work to be
accomplished, and any special conditions of
the project. Within three calendar weeks of
receiving the grant agreement, you must
either sign and return the agreement to EPA
or request that EPA extend the time for
acceptance. If you do not do one of these
two things (sign or ask for more time), the
grant agreement will 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. With one exception, you may
not incur any costs until both you and the
EPA Award Official have signed the grant
agreement. The only exception is the costs
of incorporating.
The award of a grant agreement is a public
trust. By signing and accepting a grant
agreement, you are promising to comply with
all terms and conditions of the grant agree-
ment, including any special conditions neces-
sary to assure compliance with applicable
EPA and state laws, regulations, and policies.
You are responsible for efficiently and effec-
tively managing the project, completing the
project according to the schedule, and meet-
ing all monitoring and reporting requirements.
EPA is not obligated, however, to provide
Federal funds for any costs incurred by your
group in excess of the Federal share of your
approved budget.
When you receive your grant, note carefully
the:
• Dollar amount awarded;
• Project period shown on the first page;
• Approved budget;
• Non-federal percentage shown; and
• Any special conditions included.
These items represent legally-binding terms
of the grant. You must adhere to them.
They can be changed only through a grant
amendment (see Part 3).
April 1990
-------
1-14
-------
1-15
Step-by-Step Application
Instructions
This section provides step-by-step instructions on completing each of the forms
required to submit a TAG application. These forms include:
• APPLICATION FOR FEDERAL ASSISTANCE (EPA Form 5700-33 and Standard
Form 424);
Part I: General Information, Signature, and Certification
Part II: Project Approval Information
Part III: Budget Information
Part IV: Project Narrative Statement
Part V: Assurances
• PROCUREMENT SYSTEM CERTIFICATION (EPA Form 5700-48); and
• CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS (EPA Form 5700-49) (needed only if your group is seeking a grant
of $25,000 or more).
These instructions are intended to walk you through the process of filling out each
form. In addition to the instructions, sample completed versions of all three forms
can be found in the section that follows this one. Blank versions of all three forms
are provided at the end of Part 1 for your convenience. Before you sit down to fill
out your application, you may find it useful to photocopy the blank application
forms to create a draft set. If questions arise as you complete these forms, please
do not hesitate to discuss them with your EPA Regional Office.
You will find "do's and don'ts" at the end of this section on page 1-31, followed by
"commonly asked questions" on page 1-33. A checklist to assist you in completing
the grant application is provided on page 1-71.
April 1990
-------
Application Instructions 1-17
Application For Federal
Assistance
ITEM
INSTRUCTIONS
NOTE: See page 1-41 for a sample completed application and page 1-75 for a blank
application form. To simplify your work, EPA has filled in those items on the grant forms that
are the same for all TAG applicants.
PART I - General Information, Signature, and Certification
Section I - Applicant/Recipient Data
1. Type of Submission
2. Applicant's Application
Identifier
a. Number
b. Date
3. State Application
Identifier
a-b.
4. Legal Applicant/Recipient
5. Employer Identification
Number
6. Program
Do not complete. This has been filled in for you.
Leave blank.
Write the current date.
Leave blank.
List the name and address of your group and the name and
telephone number of a contact person who would be able to
supply additional information if necessary. "Organization unit"
is not applicable to TAG applicants.
Contact your EPA Regional Office to determine whether this
item applies to you.
Do not complete. This has been filled in for you.
April 1990
-------
1-18
Application Instructions
APPLICATION FOR FEDERAL ASSISTANCE, page 1 (continued)
ITEM
INSTRUCTIONS
7. Title of Applicant's
Project
8. Type of Applicant/
Recipient
9. Area of Project Impact
10. Estimated Number of
Persons Benefitting
11. Type of Assistance
12. Proposed Funding
Enter the name of the Superfund site for which the grant will
be used.
Do not complete. This has been filled in for you.
List the municipality(ies) and county(ies) adjacent to, encom-
passing, and affected by, the site.
Enter the number of persons directly affected by the site.
You may estimate this number or obtain it from the site's
National Priorities List description, which an EPA contact can
provide. (See "References" section of this handbook.)
Do not complete. This has been filled in for you.
Enter the appropriate amount of funds that will be needed for
the first budget period, as indicated in the Statement of Work
(Part IV, Section 2, of this application). EPA will not provide
more than $50,000 for any site in the initial award. The
amount in line "a," EPA's proposed funding, cannot be more
than 80 percent of the amount in line "f," the total funding.
13. Congressional Districts
of:
a. Applicant
b. Project
Write the district number and state abbreviation of the member
of Congress who represents the area where the offices of the
incorporated group are located.
Write the district number and state abbreviation of the member
of Congress who represents the area that encompasses the
site.
14. Type of Application
Write the appropriate letter in the box (such as "A" for new or
"B" for a continuation application.
April 1990
-------
Application Instructions 1-19
APPLICATION FOR FEDERAL ASSISTANCE, page 1 (continued)
ITEM
INSTRUCTIONS
15. Project Start Date
16. Project Duration
17. Type of Change
18. Date Due to Federal
Agency
19. Federal Agency to
Receive Request
20. Existing Federal Grant
Identification Number
21. Remarks Added
Section II -- Certification
Ask your EPA Regional Office the date that funding for your
grant is likely to be approved if you receive an award. Write
in this date or the date when you wish to begin receiving
funds, whichever date is later.
Estimate (in months) the length of the project period. This
cannot exceed 36 months (three years) for the initial award.
Enter "NA" (not applicable) for an initial application. Enter "E"
for a continuation application.
Leave blank.
Enter your EPA Region's number, contact, and address. (See
"References" section of this handbook for addresses.)
Write "NA" for initial application; for all continuation applica-
tions, enter the EPA Assistance Identification Number assigned
to the grant.
If using Section IV (Remarks) to further discuss other informa-
tion contained in the grant application, check yes. (See
Section IV below.)
22. The Applicant Certifies
That:
This program may be subject to intergovernmental review by
your state government. To find out, you must call or write
your state's intergovernmental review contact (see the
"References" section of this handbook for a list). That person
can explain how and where to submit your application for
state review. If your state requires review, enter in Item 22
that the application has been made available to the ap-
propriate state contact. If your state does not want to review
your application, check the second box under "b." BEGIN
THIS PROCESS EARLY TO AVOID DELAYS.
April 1990
-------
1 -20 Application Instructions
APPLICATION FOR FEDERAL ASSISTANCE, page 1 (continued), 2, and 3
ITEM
INSTRUCTIONS
23. Certifying Representative
Your group's Project Manager (the officer authorized to
obligate your group to the conditions of the grant agree-
ment/application) must sign this item.
Section III - Federal Agency Action
24-33.
Section IV - Remarks
Leave blank. This section is filled out by EPA.
In Section IV, "Remarks," please provide a one or two
sentence summary description of your proposed project. You
may also use this section to expand on your answers in
Sections I and II. If you do this, please reference the item
that you are expanding upon (for example, "Section I, #7").
PART II - Project Approval Information
1 -2.
3.
4 - 5.
6. Will the assistance request
serve a federal installa-
tion?
7. Will the assistance re-
quested be on federal
land or installation?
Do not complete. This has been filled in for you.
Call your state's intergovernmental review contact (see
"References" section) to find out whether your state requires
review. Check yes or no accordingly.
Do not complete. This has been filled in for you.
This question refers to assistance to the people who work at
a federal facility, while the next question refers to the physical
location. Check yes if the NPL site is a federally-owned
facility. This information can be provided by the appropriate
EPA Regional contact listed in the "References" section.
Site-specific; provide information on the site if it is a federal
facility.
April 1990
-------
Application Instructions I "21
APPLICATION FOR FEDERAL ASSISTANCE, page 3 (continued) and 4
ITEM
INSTRUCTIONS
8. Will the assistance re- Do not complete. This has been filled in for you.
quested have an impact or
effect on the environment?
9. Has the project for which
assistance is requested
caused, since January 1,
1971, or will it cause, the
displacement of any indi-
vidual, family, business,
or farm?
Do not complete. This has been filled in for you.
10. Is there other related as- Fill in if you are receiving technical assistance funds from
sistance on this project another federal agency. (Generally, no affected applicant
previous, pending, or groups will have received funds from another federal agency
anticipated? for the purpose of technical assistance at the Superfund site
in question.)
11. Is project in a Designated Site-specific; consult the appropriate EPA Regional contact
Flood Hazard Area? listed in the "References" section.
Part III - Budget Information
Section A - Budget Summary
1. Grant Program, Func- Enter the name of the Superfund site on line 1.
tion, or Activity
Federal Catalog No.
2-5.
Do not complete. This has been filled in for you.
Write "See Detailed Budget In Part IV, Section 2(B)" in line 2
across columns (d)-(g). Budget information is requested in
Part IV narrative.
Section B - Schedule A Budget Categories
6. Grant Program Function Do not complete. This has been filled in for you.
or Activity
6a-6k and 7.
Write "See Detailed Budget in Part IV, Section 2(B)" in line 6(b)
across columns (2)-(5).
April 1990
-------
-22 Application Instructions
APPLICATION FOR FEDERAL ASSISTANCE, pages 5 and 6
ITEM INSTRUCTIONS
Section B - Schedule B Budget Categories
6a. Program Elements Enter the name of the Superfund site on line (a).
b-j. Write "See Detailed Budget in Part IV, Section 2(B)" in line 6(b)
across columns (1)-(3). You need not provide budget figures
here.
Section C - Non-Federal Resources
8a. Grant Program Enter the name of the Superfund site in column (a).
8b-8e and 9-12. Write "See Detailed Budget in Part IV, Section 2(B)" in line 9,
across columns (c) and (d).
Section D - Forecasted Cash Needs
13-14. Federal/Non-Federal Section D represents the cash needs of the first year of your
three year budget period. Enter the estimated dollar amounts
for the stated time periods. Use the proposed three year
schedule of tasks included in the Statement of Work (Part IV)
below to estimate first year cash needs. (Don't spend a lot
of time on this section -- a rough estimate is fine.)
15. Totals Total the amounts of lines 13 and 14 for each column.
Section E - Budget Estimates of Federal Funds Needed For Balance
16. Grant Program Funding
Periods
a. Enter the name of the Superfund site.
16b-20e. In columns (b), (c), (d), and (e), enter your rough estimate of
the amount of federal funds needed for technical assistance
for the years after the initial grant. (This refers to any grant
funds you expect to have left after three years.)
April 1990
-------
Application Instructions 1-23
APPLICATION FOR FEDERAL ASSISTANCE, page 6 (continued) and 7-11
ITEM
INSTRUCTIONS
Section F -- Other Budget Information
21. Direct Charges Do not complete. This does not apply to TAG applicants.
22. Indirect Charges
Do not complete. This does not apply to TAG applicants.
PART IV » Project Narrative Statement
The forms for Part IV follow a question and answer format which is, for the most part, self-
explanatory. To illustrate the type of information sought, the sample application in the "Sample
Documents" section of Part 1 shows the questions filled in with the "answers" (in italic type)
of a hypothetical group called the Woodtown Landfill Coalition. Additional guidance is given
below for Items B2, B5, B7, C1, and C5 in Section 1 and Items A and B in Section 2.
Section 1 -- Group Qualifications
B2. Resources for Project
Completion
B5. Incorporation
The value of equipment, such as an adding machine or
typewriter supplied by your group, may be counted as an in-
kind contribution. However, only that portion of the property's
use directly attributable to the TAG project counts as an in-
kind contribution. The value of donated space, such as an
office for the technical advisor(s), may be considered an in-
kind contribution, but it must not exceed the fair rental value
of comparable space in a privately-owned building in your
community. If the donated space is used for purposes other
than the TAG project, only the portion associated with the
TAG project may count as an in-kind contribution.
You may meet the incorporation requirement by stating that
your group, if not incorporated, has plans for incorporating if
it is awarded a grant. Once your group is awarded a grant,
you must affirm that your group has filed the necessary
papers for incorporation with the state. However, on or
before your first request for payment, you must submit to EPA
documentation (such as a letter from the state) that your
group has been incorporated officially by the state. If your
group is incorporated for some other purpose and has a
substantial history of involvement at the site, you must
April 1990
-------
1-24 Application Instructions
document this involvement for EPA.
APPLICATION FOR FEDERAL ASSISTANCE, page 11 (continued), 14
ITEM
INSTRUCTIONS
B6. Drug-Free Workplace
Policy
C1. Health Considerations
C5. Economic/Environmental
Considerations
This statement is necessary to comply with the Anti-Drug
Abuse Act of 1988.
Under this item, you should explain whether your group
members are subject to demonstrable health threats, whether
actual or potential, or to a threat that group members reason-
ably believe to be substantial. However, your inability to
provide documentation of health problems related to the site
will not necessarily prevent you from receiving a grant,
provided the other criteria are met.
EPA is trying here to establish whether your group members
are subject to:
• A demonstrable economic threat;
• Impairment of the group's use and enjoyment of the
environment, whether actual or potential; or
• A threat that is reasonably believed to be substantial.
If you are unable to provide documentation of economic or
environmental problems related to the site, you may still be
able to obtain a grant, provided other criteria are met.
Section 2 - Narrative Statement of Work for the Technical Advisor
A.
Statement of Work
This item requires a succinct explanation of what you plan to
have your technical advisor(s) do at each stage of the site
cleanup process. Be as complete as possible. To change
this list of activities, you will have to get EPA's written
approval. Attachment 1.A. in the sample application
(page 1-58) shows one way of providing a Statement of Work.
You may use a different format to provide this information if
you wish. You should show estimates of the advisor's time
to conduct his or her services during each phase of the
cleanup process and the products you expect the advisor to
provide.
April 1990
-------
Application Instructions 1 -25
APPLICATION FOR FEDERAL ASSISTANCE, pages 15 and 16
ITEM
INSTRUCTIONS
B. Detailed Budget
This item requires you to translate the three-year Statement of
Work into dollar figures. Attachments 1.B. and 1.C. in the
sample application (pages 1-59 and 1-60) show one way of
doing this. Attachment 1 .B. breaks the general activities from
Attachment 1A down into specific tasks, hours, and dollars.
Attachment 1.C. summarizes costs by type of activity and
indicates whether they will come from TAG funds or the
group's matching contribution. Those costs covered by the
group's match should agree with the costs indicated in Part
III, Section B of the Application for Federal Assistance. The
goods and services listed should include everything you think
you will purchase with grant funds or with your group's
matching share. To add items to the budget later, you will
need EPA's written approval.
PART V -- Assurances
This part contains the regulations, policies, guidelines, and requirements to which your group
must adhere. You should read these carefully and them sign at the bottom of the page. Be
sure to submit this sheet with the rest of your application package.
April 1990
-------
Application Instructions 1-27
Procurement System
Certification (EPA Form
5700-48)
NOTE: See page 1-63 for sample completed version and page 1-93 for blank version.
Section I
Enter your group's name and address as it appears on the main application form.
You may leave the section under "Assistance Application Number" blank.
Section II
A. Most groups will not complete Section II (A) because they will not have previously
obtained an EPA assistance agreement.
B. Because most groups will not have a certifiable procurement system (box #1), most
groups will check box #2 of Section II(B) to indicate that they will comply with 40 CFR
Part 33 as their procurement rule and allow EPA to review their proposed contract with
their technical advisor(s) before the contract is signed. Your group's project manager
must sign and date the bottom of this form. Be sure to submit this signed form with the
rest of your application.
April 1990
-------
Application Instructions 1-29
Certification Regarding
Debarment, Suspension, and
Other Responsibility Matters
(EPA Form 5700-49)
NOTE: Both the TAG applicant and the technical advisor candidate^) must submit this form.
(See Part 2 for the technical advisor's instructions.) You will find a sample completed version
on page 1 -67 and a blank version on page 1 -97.
Instructions for TAG Applicants
On the first line, enter your group's name and the name and title of your group's project
manager, as they appear on page 1 of the main application form under Items 4 and 23(a).
Your group's project manager must sign and date the second line.
If your group cannot sign this certification, check the box and attach an explanation of
why you cannot.
April 1990
-------
Do's and Don'ts In Applying
For A Technical Assistance
Grant
1-31
Do's
Don'ts
Do make an effort to form coalitions
with other concerned individuals or
groups of individuals in order to
submit a single application for the
grant awarded to your site.
Do put down the correct Congres-
sional district on your grant applica-
tion.
Do talk with the EPA Remedial Pro-
ject Manager at the site before
preparing the Statement of Work
(Part IV) for your application.
Do be sure your budget figures add
up correctly.
Do be sure to sign the bottom of
Part V of the application ("Assur-
ances") and submit it with your
application.
Do be sure to include in your
application the procurement and
debarment certification forms.
Do comply with your state's inter-
governmental review requirements.
Do contact your EPA Regional Office
for assistance if you need it.
Do submit the signed original version
of your application and 2 copies.
Don't spend too much time on the
budget forecasting components of
the application (Part III, Sections D
and E). This information need only
be approximate.
Don't spend too much time on the
Narrative Statement of Work (Part IV
of the Application). EPA will ask you
for more information if necessary.
Don't delay signing the application.
It will delay the award of the grant.
Don't hire EPA or state employees
to help prepare your application.
Don't include PRPs in your group.
April 1990
-------
Commonly Asked Questions
About Applying For A
Technical Assistance Grant
1-33
Is A LOCAL CHAMBER OF COMMERCE
ELIGIBLE To RECEIVE A TAG?
Chambers of Commerce as a group typically
are not eligible for TAGs. A chamber is not
incorporated for the purpose of addressing
Superfund site problems, and is unlikely to
have a substantial history of involvement at the
site. In addition, their individual members may
not be "affected" individuals. Finally, a
chamber may include Potentially Responsible
Parties or other ineligible entities among its
members, which ordinarily would make it
ineligible.
Do WE HAVE To USE A THREE-YEAR
BUDGET PERIOD?
It may be possible to use a budget period of
another length. Those applicants considering
budget periods of lengths other than three
years should discuss this with their EPA
Regional Office before filling out the
application.
Is THE COST OF INCORPORATING
CONSIDERED AN ELIGIBLE ACTIVITY
UNDER THE GRANT?
Yes. This cost is considered an eligible pre-
award cost and may be charged to the grant
or counted toward the matching funds require-
ment.
CAN WE USE GRANT FUNDS To PAY
SOMEONE WHO HELPED PREPARE OUR
APPLICATION?
No. Your group can use someone to prepare
the grant application, but you cannot pay that
person with grant funds. Necessary and
reasonable costs incurred by your group to
incorporate are the only costs you may incur
before you receive a grant and still be
reimbursed for them. You cannot count the
time you spend preparing your TAG
application as an in-kind contribution.
SHOULD WE USE GRANT FUNDS To
PAY SOMEONE To MANAGE OUR GRANT
FOR Us?
No. TAG awards should be used to pay for
activities directly related to interpreting and
communicating technical cleanup information
for lay people, rather than for managerial
activities. One of your group members may
be able to donate such managerial skills,
which can be counted as an "in-kind" con-
tribution.
WHERE CAN I OBTAIN FURTHER INFOR-
MATION ABOUT INCORPORATION?
General information concerning your state's
laws of incorporation may be obtained from
the state governor's office, a private lawyer,
or a local legal services agency. Specific
questions concerning the effect of incorpora-
tion on taxes can be answered by the U.S.
April 1990
-------
1 "34 Commonly Asked Application Questions
Internal Revenue Service or state tax offices.
The local public library often is an excellent
source of information on this subject.
WHAT ARE SOME EXAMPLES OF IN-KIND
CONTRIBUTIONS?
In-kind contributions may come in the form of
donations of equipment (for example, a word
processor, typewriter, or copier), office space,
or supplies (such as paper and pencils).
Volunteer services may also be counted as
in-kind contributions; these may include:
• A bookkeeper's maintenance of your
group's financial records and prepara-
tion 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 the
technical advisor's contract; and
• A group member's efforts to write and
distribute your newsletter to the com-
munity.
A variety of other costs may also be counted
as in-kind contributions, including telephone
calls, publication of a public notice seeking
qualified advisors, postage and printing of
newsletters, copies of project documents, and
fees for public meeting facilities. Your group
must keep records documenting all of these
types of contributions.
CAN A GROUP RECEIVE MORE THAN
$50,000 FOR PROPOSED SITES?
No. Sites proposed for the National Priorities
List (NPL) are not eligible for deviations from
the $50,000 grant ceiling. Deviations from the
ceiling may be considered only after a site is
formally listed on the NPL.
April 1990
-------
1-35
Sample Application
Documents
To assist you in completing the TAG application, completed samples of the required
forms are included in this section. The sample completed forms that follow illustrate
the detailed instructions provided earlier in Part 1. Blank copies of these completed
forms begin on page 1-73. The blank forms can be used by your group to
complete your TAG application. You will find the following sample forms in this
section:
• Letter of Intent;
• Application for Federal Assistance;
• Procurement Certification; and
• Certification Regarding Debarment, Suspension, and Other Responsibility
Matters.
You will find a checklist to assist you in completing the grant application at the end
of this section on page 1-71. "Do's and don'ts" and "commonly asked questions"
are provided on pages 1-31 and 1-33.
April 1990
-------
Sample Application Documents 1 -37
Letter of Intent
-------
Sample Application Documents 1 "39
Letter of Intent
Woodtown Landfill Coalition
Main Street
Woodtown, CT 06898
May 3, 1990
TAG Project Officer
Superfund Management
EPA Region 1
Mail Code: HDA-CAN4
John F. Kennedy Federal Building
Boston, MA 02203
Dear Sir/Madam:
This letter has been prepared by the Woodtown Landfill Coalition to announce this
group's intention to apply for a Technical Assistance Grant. The coalition, which is comprised
of the Woodtown Citizens Task Force and the Smithtown Outing Club, plans to use any
awarded grant funds for obtaining assistance in interpreting technical information generated
during the Superfund cleanup process at the Woodtown Landfill site in Litchfield County,
Connecticut. Please send an application and other relevant materials to the Woodtown Landfill
Coalition in care of Pat Jones at the address listed above. The group hopes to file its
application in July 1990.
Sincerely,
Pat Jones, Executive Director
Woodtown Landfill Coalition
-------
1-40
-------
Sample Application Documents 1-41
Application for Federal Assistance
[EPA Form 5700-33 (Rev. 11-86), Standard Form 424]
-------
Sample Application Documents 1 -43
FEDERAL ASSISTANCE
1. TYPE
OF
SUBMISSION
(Mark of
pnfriatt
taxi
D NOTICE OF INTENT (OPTIONAL)
D PREAPPUCATON
APPLICATION
2. APPLI-
CANTS
APPLI-
CATION
IDENTI-
FIER
a. NUMBER
b. DATE
fear month Jay
19 90 7 10
3.' STATE
APPLI-
CATION
IDENTI-
FIER
NOTE: TO BE
ASSIGNED
BY STATE
.NUMBER
b. DATE
ASSIGNED
Ytar month day
19
Lunt
Blank
4. LEGAL APPLICANT/RECIPIENT
a.ApplicantName Woodtown Landfill Coalition
b. Organization UnH
c. s&»et/P.O. Box Main Street
d. City Woodtown •. County
f: Stale CT g. ZIP Code.
h. Contact Person (Nam* Pat Jones
A Telephone NO.) (2Q3) ###-####
Litchfield
06898
5. EMPLOYER IDENTIFICATION NUMBER (EIN)
NA
e.
PRO-
GRAM
(From CFDA)
a. NUMBER | 6 [6 j ' | 8 JO f
MULTIPLE D
b. TITLE Superfund Technical
Assistance Grant
7. TITLE OF APPLICANTS PROJECT (Use faction IV of this form to provide • summary description of the
project)
Technical Assistance at the Woodtown Landfill Site
8. TYPE OF APPLICANT/RECIPIENT
O-Sp»oil PUPOM OWnct
H— CoiiimOy Aden Agmcy
1— rt*w eajcMcx* InMUUn
.1 mj»i Trt»
E-C%
Enter appmpr jte letter [K |
Non-Profit Citizen Organization
9. AREA OF PROJECT IMPACT (Names ofcitia. counties, stata. etc.)
Smithtown, Woodtown, Litchfield, CT
10. ESTIMATED NUMBER
OF PERSONS BENEFITING
11. TYPE OF ASSISTANCE
dram
7.000
uriffm- [T~| I
f limrttj |" I I
PROPOSED FUNDING
FEDERAL
b. APPLICANT
e. STATE
d. LOCAL
e. OTHER
Total
» 50.000 .00
12,500
.00
.00
.00
.00
s 62,500 .00
13.
CONGRESSIONAL DISTRICTS OF:
14. TYPE OF APPLICATION
a. APPLICANT
6 (CT)
15. PROJECT START
DATE
19
Ytar month art
91 9 1
18. DATE DUE TO
FEDERAL AGENCY •«•
b. PROJECT
6 (CT)
E—AugramMon
Enter opproprtaH tetttr I
16. PROJECT
DURATION
36
17. TYPE OF CHANGE (Far 14c or 14t>
r-Qtm (Sftafyl:
NA
C inr.imi CXrator
Months
19
month day
Enter ippro-
pntto btterts)
19. FEDERAL AGENCY TO RECEIVE REQUEST
EPA
a. ORGANIZATIONAL UNIT (IF APPROPRIATE)
Region I
b. ADMINISTRATIVE CONTACT (IF KNOWN)
20. EXISTING FEDERAL GRANT
IDENTIFICATION NUMBER
NA
c. ADDRESS
JFK Federal Building
Boston, MA 02203
21. REMARKS ADDED
X
-YfiS_
D
No
22.
THE
APPLICANT
CERTIFIES
THAT*
To tfw b«M ol my knowledge and belM,
data in ttw pnappHcatton/appHcatton
are true and correct (he document h«a
been duly authortzed by the govemina
body of the applicant and the applicant
w* compry with the attached aMurancee
H the anittance is approved.
a YES, THIS NOTICE OF INTENT/PREAPPUCATION/APP1JCATION WAS MADE AVAILABLE TO THE STATE"
EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
DATE n7/in/Qfi
b. NO. PROGRAM IS NOT COVERED BY E.O. 12372 D
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW D
23
CERTIFYING
REPRE-
SENTATIVE
a. TYPED NAME AND TITLE
Pat Jones
Executive Director
b. SIGNATURE
24. APPLICA-
TION
RECEIVED 19
Year month day
25. FEDERAL APPLICATION IDENTIFICATION NUMBER
28. FEDERAL GRANT IDENTIFICATION
27. ACTION TAKEN
Q a AWARDED
D b. REJECTED
D c. RETURNED FOR
AMENDMENT
D d. RETURNED FOR
E.O. 12372 SUBMISSION
BY APPLICANT TO
STATE
O e. DEFERRED
Of. WITHDRAWN
28.
FUNDING
a. FEDERAL
b. APPLICANT
c. STATE
o'. LOCAL
e. OTHER
f.
TOTAL
.00
.00
.00
.00
.00
.00
Year month day
29. ACTION DATE*
19
31. CONTACT FOR ADDITIONAL INFORMA-
TION (Name and telephone number)
30
STARTING
DATE 19
Year month dau
32.
ENDING
DATE
Year month dau
19
33. REMARKS ADDED
Yes
D
No
•PA Form 5700-33 (Rev. 11-86)
SAMPLE GRANT APPLICATION - Page 1 of 16
-------
1 -44 Sample Application Documents
SECTION IV-REMARKS IPlMm rtftrtoc* tt* prop* ittm stucnter from Sfctioni I, II or III,
The Woodtown Landfill Coalition is seeking funds to obtain a technical advisor
to provide assistance in the review and analysis of remedial activities at the
Woodtown Landfill Superfund site. The technical advisor will assist Coalition
members in interpreting documents generated throughout the Superfund process
at the Woodtown Landfill site.
EPA Form 5700-33 (Rev. 1 1-86)
SAMPLE GRANT APPLICATION - Page 2 of 16
-------
Sample Application Documents 1 -45
PART II
PROJECT APPROVAL INFORMATION
Form Approved
OMB No 2030-0020
Approval expires 7-31-89
Item 1.
Does this assistance request State, local, regional, or other priority
rating?
Yes X No
Name of Governing Body .
Priority Rating
Item 2.
Does this assistance request require State or local advisory, edu-
cational, or health clearances?
Name of Agency or
Board
-Yes
.No (Attach Documentation I
Item 3.
Does this assistance request require clearinghouse review in ac-
cordance with Executive Order 12372?
(Attach Comments}
X
Yes
.No
Item 4.
Does this assistance request require State, local, regional or other
planning approval?
Name of Approving Agency.
Date
.Yes
_No
Item 5.
Is the proposed project covered by an approved comprehensive
plan?
, Yes
.No
Check one: State D
Local D
Regional D
Location of Plan _____
Item 6.
Will the assistance requested serve a Federal installation?
Yes X No
Name of Federal Installation
Federal Population benefiting from Project ,
Item 7.
Will the assistance requested be on Federal land or installation?
-Yes
.No
Name of Federal Installation ,
Location of Federal Land
Percent of Project
Item 8.
Will the assistance requested have an impact or effect on the
environment?
X Yes
.No
See instructions for additional information to be provided.
The assistance is intended to
facilitate site response actions.
Item 9.
Has the project for which assistance is requested caused, since
January 1, 1971, or will it cause, the displacement of any individual,
family, business, or farm?
x
Number of:
Individuals.
Families
Businesses.
Farms
.Yes
.No
Item 10.
Is there other related assistance on this project previous, pending,
or antici'peted?
X
See instructions for additional information to be provided.
.Yes
.No
I* project in a Designated Flood Hazard Area?
-Ya«
X
-No
EFA Fcrm 5700-33 (Rev. 11-86}
SAMPLE GRANT APPLICATION - Page 3 of 16
-------
1 "46 Sample Application Documents
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Sample Application Documents 1 -47
SECTION B - SCHEDULE B - BUDGET CATEGORIES
6. Program Elements
Technical Assistance at:
b.
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EPA Form 5700-33 (Rev. 11-86)
SAMPLE GRANT APPLICATION - Page 5 of 16
-------
1 -48 Sample Application Documents
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SAMPLE GRANT APPLICATION - Page 6 of 16
-------
Sample Application Documents 1 -49
PART IV - Narrative Project Statement
Part IV consists of two sections. The first section, "Group Qualifications," is used by EPA to
obtain information about your group's eligibility, characteristics, and plans for using grant funds.
The second section of Part IV is the Narrative Statement of Work for the technical advisor(s).
In this section, your group describes how a grant award would be used with respect to
Superfund technical milestones (for example, review of the Remedial Investigation Report) and
provides your proposed budget.
To help determine projected tasks for your advisor and a tentative schedule in preparing the
Statement of Work, you are encouraged to review the pamphlets on the Superfund and TAG
Programs and the fact sheet entitled "Summary of Public Documents Prepared During the
Remedial Process" that accompany this handbook. Also, review the Introduction to this
handbook, which discusses the role of the technical advisor(s) and the sample application in
the "Sample Documents" section of Part 1. For each task indicated in the Statement of Work,
you will need to estimate the amount of review time to be allotted to your technical advisor(s).
Section 1 (Group Qualifications)
A. Group Eligibility
1. Is your group part of any of the following organizations? If the answer is yes,
check the categories below that apply.
Potentially Responsible Parties;
Academic Institutions;
Political Subdivisions (e.g., townships and municipalities; or local
government); and
Groups established and/or sustained by a state or local government.
SAMPLE GRANT APPLICATION - Page 7 of 16
-------
I -50 Sample Application Documents
PART IV - Narrative Project Statement (continued)
2. How many members are in your group? 105 Is it made up of a coalition of
groups? yes (yes/no) If so, how many, and how did the groups come together?
If not, how was your group formed?
The Woodtown Landfill Coalition is composed of members from two groups —
the Woodtown Citizen Task Force of Woodtown, CT and the Smithtown Outing
Club of Smithtown, CT. The main concern of the Woodtown Citizen Task
Force, formed in 1986, is health effects resulting from the contamination at the
site. The Smithtown Outing Club, founded in 1965, organizes a variety of out-
door trips around Litchfield County. The Club's main concern is the effects of
contamination from the Woodtown Landfill site on the surrounding environ-
ment. Since both groups require technical assistance, they have chosen to form
an incorporated coalition for the purposes of this program.
B. Responsibility Requirements
1. Administrative and Management Capabilities: Please briefly describe the organi-
zational structure of your group in the space below. (Describe roles and respon-
sibilities of members, particularly members who will be responsible for financial
management of the grant and directing the activities of the technical advisor.)
Both the Woodtown Citizen Task Force and the Smithtown Outing Club have
operated as non-profit organizations for at least five years and have existing
administrative structures that oversee and guide their activities. The Woodtown
Landfill Coalition is also non-profit, and wttl be managed by a four-person
executive committee composed of the two presidents and the two treasurers of
the respective groups. One member of the executive committee has been
designated as Executive Director of the Coalition. The Executive Director will
be the group's designated representative for the purposes of signing all
documents related to the grant. The Executive Committee wttl direct the
technical advisor and oversee the entire project. The two treasurers wttl be
responsible for all financial oversight. The attached bylaws provide additional
details about the administrative structure of the Woodtown Landfill Coalition.-1
-' The bylaws referred to in this part of the sample application are referred to for the sake of
instruction only, and have not actually been appended to this example because they will vary on
a case-by-case basis. Your group should include such bylaws when submitting your application
if you are incorporated.
SAMPLE GRANT APPLICATION - Page 8 of 16
-------
Sample Application Documents 1 "51
PART IV - Narrative Project Statement (continued)
2. Resources for Project Completion: What resources are available to your group
to help complete the TAG Project? (Include any plans that your group has for in-
kind contributions or for fund raising and obtaining cash.)
To complete our technical assistance project we will require the services of a
technical advisor for three years. At this time, the total estimated budget for
the entire project will be $62,500. Of this amount, the federal share will be
$50,000. We will match the federal share of $50,000 with $12,500 - 20
percent of the total project cost with a combination of cash and in-kind
contributions. The cash portion will come from annual dues and fund-raising
activities such as the Smithtown Canoe Rally and the Woodtown Recycling
Drive. In the past three years, we averaged $1,500, collectively, from these
fund-raising activities. We also have received about $500 in donations in each
of those years. In-kind contributions will come from donated meeting space,
planning activities, executive committee meetings, time spent managing the
technical advisor, accounting services, writing and editing services, and time
required to put out mailings. A local businessman (a member and an officer
of the Woodtown Citizen Task Force) will donate meeting space for use by the
Coalition on an as-needed basis throughout the life of the project. A certified
public accountant will donate services to provide accounting assistance to the
Coalition. A local freelance writer and a local newspaper editor will design,
write, and edit a newsletter devoted solely to the site and the technical assistance
project. Attachment 1A. provides a detailed budget including a breakdown of
the federal and matching shares.
3. Performance Record: Please describe your group's past performance with
satisfactorily completing projects and contracts. (If your group has no past
experience, EPA will evaluate the description, budget, and schedule you provide
in Part IV, Section 2, of this application.)
Although neither of the founding groups (Woodtown Citizen Task Force and
the Smithtown Outing Group) nor the new Coalition previously have received
federal funds, we believe the group can satisfactorily complete the proposed
TAG project. The Narrative Statement of Work included in this application
describes in detail our proposed plan for use of a technical advisor's services.
SAMPLE GRANT APPLICATION - Page 9 of 16
-------
I -52 Sample Application Documents
PART IV - Narrative Project Statement (continued)
Attachment I.B., "Proposed Schedule and Costs for Technical Advisor" ties
our Statement of Work to our budget.-1 The primary areas of past involvement
are health and environmental concerns.
4. Accounting and Auditing Procedures: What procedures does your group plan
to use for recordkeeping and financial accountability related to the grant? Please
identify the member of your group who will maintain your financial records.
Our financial management system complies with generally accepted accounting
procedures. We will establish and maintain a separate bank account and a
general ledger solely for the management of the Technical Assistance Grant.
The two treasurers on the Executive Committee, Mary Jones and Fred Smith,
will maintain all financial records related to the grant. These records will be
stored in a central file in the same office where Coalition meetings will be held.
A phone log will be maintained by the Coalition's officers. In addition, the
technical advisor will be expected to keep a telephone log and other records of
his/her activities and expenditures.
A member of the Woodtown Landfill Coalition, originally from the Smithtown
Outing Club, is a certified public accountant and has volunteered to assist in
the financial oversight of grant funds. He will advise the group on completing
financial reports required by EPA and the state. In addition, an outside
accounting firm will be brought in to perform an independent audit every other
year, as required by federal regulations.
-' Attachment 1 .B. illustrates one way of displaying tasks, timeframe, and budget. TAG applicants
may display this information in a different way if they choose.
SAMPLE GRANT APPLICATION - Page 10 of 16
-------
Sample Application Documents I -53
PART IV - Narrative Project Statement (continued)
5. Incorporation: Is your group incorporated specifically for the purpose of
addressing problems at this site? yes (yes/no) If not, what steps is your group
taking to incorporate for grant-related purposes?
The Woodtown Landfill Coalition filed for and received approval from the state
of Connecticut for incorporation as a non-profit organization. Attached is a
copy of the letter from the state approving the group for incorporation. In
addition, a copy of the group's bylaws has been attached.^ This document
provides a description of the administrative structure of the Woodtown Landfill
Coalition and general group goals.
6. Does your group have a substantial history of involvement at the site? yes
(yes/no) (If so, please include a brief description of your group's involvement.)
The primary areas of past involvement have been health and environmental
concerns. The Woodtown Citizen Task Force and the Smithtown Outing Club
have both held numerous meetings to discuss and publicize concerns about the
Woodtown Landfill site, dating back to July 1985. Activities conducted by the
two groups have included: writing to local officials, the Connecticut Congres-
sional delegation, and EPA to request help in evaluating health risks and getting
the site cleaned up; arranging for bottled water; press conferences; fund raising
drives; well testing; and mapping the contamination.
7. Drug-Free Workplace Policy: Does your group promise not to engage in illegal
drug-related activities while carrying out activities using TAG funds?
(yes/no)
-1 The letter and bylaws referenced above have not actually been appended to this example
because they will vary from case-to-case considerably. They are referred to in this sample
application only for illustration.
SAMPLE GRANT APPLICATION - Page 11 of 16
-------
1 -54 Sample Application Documents
PART IV - Narrative Project Statement (continued)
C. Group Issues and Objectives
1. Health Considerations: How many group members have experienced health
effects from contamination at the site? unknown Describe actual or potential
health threats the site poses to individual group members and the efforts members
of your group have undertaken to resolve or make known these health concerns.
Concern about contaminated private wells and possible health effects resulting
from the contamination at the site led to the initial formation of the Task
Force. As explained in a private sampling report, residents' well water continues
to be undrinkable due to its strong odor, brownish color, and unpleasant taste
which the Task Force believes to be solely caused by contamination from the
Woodtown Landfill site. Several residents have reported to the Task Force that
they have experienced mysterious skin rashes after bathing in the wett water and
are concerned about their health. As a result, Task Force members have had
to resort to using bottled water for nearly four years. EPA is considering
members' request for an alternate water supply after the Agency has completed
their sampling at the landfitt. The Woodtown Citizen Task Force, as a member
of the Woodtown Landfill Coalition, wants to ensure specifically that all
potential health risks related to the site are investigated thoroughly and that the
remedial action selected will restore the quality of their private wett water
supplies.
2. Consolidation/Representation: Describe the number and diversity of affected
community organizations and individuals represented by your group, highlighting
the ways in which your group represents affected individuals affected by the site.
The Woodtown Landfill Coalition has a diverse membership which represents
much of the community's interests and concerns about the Woodtown Landfill
site. Coalition members believe that this organized effort will positively affect
both members of the group and individuals in the community by providing a
single contact from which community concerns can be addressed. The Coalition
itself does not have a long history with the Woodtown Landfill site, but its
composite organizations have been active in dealing with site issues since the site
was listed on the National Priorities List in 1986.
SAMPLE GRANT APPLICATION - Page 12 of 16
-------
Sample Application Documents 1 -55
PART IV - Narrative Project Statement (continued)
3. Tasks for Technical Advisors: Please describe how your group intends to use
your technical advisor to interpret technical Superfund information.
The primary purpose of the tasks to be performed by the technical advisor is
to help the members of the Woodtown Landfill Coalition better understand the
technical information, data, reports, designs, and oral presentations provided by
EPA and the state in the course of studying and conducting remedial activities
at the Woodtown Landfill site. By interpreting, analyzing, and evaluating the
information, the technical advisor will aid our group in commenting more
productively and effectively on remedial activities at the site. The ultimate goal
of the technical assistance project is to help us help EPA clean up our drinking
water and restore the Rolling River to its previous recreational uses. A more
detailed description of the tasks to be performed by the technical advisor is given
in the Narrative Statement of Work (Attachment 1A.) and in the Proposed
Schedule of Tasks and Costs for Technical Advisors (Attachment I.B.).
4. Information Sharing: How does your group intend to share information collected
with grant funds with the larger community?
To keep community members informed of activities at the Woodtown Landfill
site, the Woodtown Landfill Coalition will produce six issues of a newsletter
containing information generated by the technical advisor (s). 300 copies of
this newsletter will be printed for each issue: 200 copies will be distributed by
hand to interested community members and 100 copies will be mailed directly
to Coalition members and the local press. In addition, all final documents
produced by technical advisor(s) will be sent to EPA to be placed in the
information repositories established for the site at locations accessible to
interested community members (Woodtown Public Library). To encourage
community involvement in activities related to the site, the Coalition will make
all of its general, monthly meetings open to the public. Additionally, prior to
EPA^ public meeting on the feasibility study, the Coalition will hold a
community forum to brief the public on the technical advisor's findings. The
Coalition will advertise the meeting by putting an ad in the local newspaper.
SAMPLE GRANT APPLICATION - Page 13 of 16
-------
1 "56 Sample Application Documents
PART IV - Narrative Project Statement (continued)
5. Economic/Environmental Considerations: How many group members have
experienced economic/environmental impacts from contamination at the site?
Please describe the actual or potential economic harm or loss of environmental
amenities the site has imposed on individual group members, and efforts group
members have undertaken to resolve or make known these concerns.
Members of the Smithtown Outing Club have, since the Club's inception in
1965, actively organized a variety of swimming, canoeing, fishing, and hiking
trips within Connecticut. Many of these club-sponsored activities have taken
place on or near the Rolling River. During the last decade, however,
contamination from the Woodtown Landfill site has polluted the river, causing
club members to fear swimming or canoeing in the river. Additionally, the state
has banned fishing in the river. As a result, this pollution has eliminated most
of the river's recreational uses. The Smithtown Outing Club, as a member of
the Woodtown Landfill Coalition, wants the Woodtown Landfill site cleaned up
so that the pollution caused by it will no longer damage the Rolling River.
A number of economic concerns face many of the members of the Woodtown
Landfill Coalition. The main worry among Coalition members is that publicity
about the contamination from the landfill may cause the property values of
homes with contaminated water or with riverfront exposure to the Rolling River
to decrease significantly. As a result, Coalition members support a timely
cleanup of the Woodtown Landfill site before the effects of site contamination
scare away potential buyers and significantly lower property values in the region.
Coalition members also have experienced significant financial burdens from not
being able to use their well water. For example, members must purchase bottled
water for drinking and cooking, and laundry cannot be washed in residential
washing machines because the clothes become stained after washing them in the
contaminated water.
Section 2 - Narrative Statement of Work for the Technical Advisor
A. Statement of Work: Please identify the technical advisor(s)' tasks for each phase of the
Superfund process. For each of these phases, please note what the technical advisor
will do, the estimated amount of time needed to complete each task, and specific docu-
ments, reports, or other tangible work products you expect the technical advisor to
produce.
See Attachment 1A. and I.B.
SAMPLE GRANT APPLICATION - Page 14 of 16
-------
Sample Application Documents 1 "57
PART IV - Narrative Project Statement (continued)
B. Detailed Budget: Prepare a budget for the technical assistance project. Indicate the
tasks to be completed by the technical advisor, the estimated number of hours, and the
cost for each task (including travel costs). Use footnotes to explain assumptions made
in the budget (such as hourly rate of advisor or adjustments for inflation). This budget
should identify everything that you expect to purchase with grant funds.
This budget should detail the amount of the group's matching contribution separately.
Note that the grant funds (usually 80 percent) plus group contribution (usually 20
percent) must equal the total project costs; grant funds cannot exceed 80 percent of
project costs for any budget period. In your statement, be sure that you differentiate
cash expenditures from in-kind contributions. Also include explanations of the assump-
tions made in calculating the value of in-kind contributions.
As discussed on pages 1 -24, 1 -25, and in Part 3, goods or services not identified in this
budget, which you later want to accept or purchase, will require written approval from
EPA. This includes goods and services in the matching share.
See Attachment l.C.
SAMPLE GRANT APPLICATION - Page 15 of 16
-------
I "58 Sample Application Documents
Attachment I.A.
Narrative Statement of Work
This section provides a detailed description of individual technical advisor tasks and their purposes. Technical
assistance tasks described in this Statement of Work are based on conversations with the EPA Regional staff
(the Remedial Project Manager and the Community Relations Coordinator for the site).
For all reports and reviews completed by the technical advisor, a memo will be prepared for the Coalition's
leadership so that information can be relayed to the membership via the newsletter. The memo and newsletter
also will be sent to EPA to be placed in the information repository for the site.
Remedial Investigation (Estimate: 134 hours, including one trip)
The advisor's first task will be to review the RI work plan, sampling plan, and quality assurance and
quality control (QAIQC) plan. Special attention will be given to how EPA plans to investigate the
migration of contamination from the Woodtown Landfill site into the Rolling River. The advisor will be
expected to attend and participate in a proposed meeting between EPA staff and residents scheduled for
the start of the RI. Upon completion oftheRI report, the advisor will be expected to help the Coalition
evaluate the results. Another key document to be reviewed by the advisor will be the risk assessment (if
available).
Feasibility Study (Estimate: 288 hours, including one trip)
The advisor will complete a detailed analysis of the proposed remedies in the draft feasibility study and then
brief the Coalition on its contents. Additionally, the advisor will prepare a written report to aid the
Coalition's preparation of public comments, specifically addressing the proposed cleanup measures. The
advisor will make a presentation on his findings at a special community forum held by the Coalition prior
to EPA's public meeting. The advisor will attend and participate in EPA's public meeting to be held in
Woodtown during the public comment period. The single, two-day trip during this period will combine both
the Coalition briefing and the public meeting.
The advisor will be expected to analyze the health assessment thoroughly to ensure that public health is
being adequately considered. The advisor will prepare a summary report on the potential health risks posed
by the site and how EPA proposes to address these risks. The advisor also will examine the ROD and
prepare a memorandum on the chosen method of cleanup. Additionally, this report will describe how major
comments submitted by the Coalition and the general community were addressed by EPA in the
responsiveness summary.
Remedial Design (Estimate: 80 hours)
The technical advisor will be expected to carry out oversight functions during this stage. The advisor will
review the final design to ensure that the design is consistent with the Record of Decision (ROD). The
advisor will be expected to report his/her findings in memoranda submitted to the Coalition's Executive
Committee. Excerpts about the progress at the site will be published in the Coalition newsletter. The
memoranda also will be available in the information repository.
Remedial Action (Estimate: 42 hours)
During the remedial action phase, the advisor will be expected to review the final inspection report. Within
30 days of the completion of the cleanup, the advisor will prepare a final report summarizing his/her
findings. This report will be published in the Coalition's newsletter.
SAMPLE GRANT APPLICATION - Attachment
-------
Sample Application Documents 1 -59
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-------
I "60 Sample Application Documents
l.
Attachment l.C.
Detailed Budget For Three Year Budget Period
Federal Share:
Labor (635 hours at $76 per hour)
Travel (site visits and attendance at
Woodtown Coalition and Public hearings)
- Milage ($.21 per mile)
~ Lodging and Meals ($100 per diem)
Other Costs
— Telephone
-- Postage
-- Copying (Reports/Memos $.05 per page)
$48,260
500
400
900
500
200
140
840
Subtotal Federal Share = $50,000
2. Matching Share:
• Out-of-Pocket Expenditures ("cash")
- Incorporation
- Newsletter (printing and postage for 6 issues,
300 copies each at $l/copy )
-- External Audit (20 hours of accounting
@ $24 per hour)
-- Supplies
• In-Kind Contributions
-- Writing newsletter (6 issues/40 hours
per issue @ $20 per hour)
-- Meeting Space ($180 per year)
-- Accountant (132 hours at $24 per hour)
-- Newsletter Editor (at $20 per hour)
-- Xeroxing newsletter (6 issues/1 page each/
300 copies/.05 per page)
$ 422
$1,800
$ 480
$ 300
$4,800
$ 540
$ 3,168
$ 900
$ 90
Subtotal Matching Share = $12,500
TOTAL (Federal and Matching) = $62,500
EPA will review your budget for excessive "administrative costs" - that is, costs not directly
related to technical advisor or distribution of information. Such costs should normally not
exceed 20 percent of your total project costs.
SAMPLE GRANT APPLICATION - Attachment
-------
Sample Application Documents 1-61
NOTE: Be sure to have your group's project manager sign and date the bottom of this form
and give his or her title.
PARTV
ASSURANCES
The Applicant agrees and certifies that he or she will comply with the regulations, policies, guidelines, and
requirements, including OMB Circulars No. A-102 and A-87, and Executive Order 12372, as they relate to
the application, acceptance, and use of Federal funds for this Federally assisted project. Also, the Appli-
cant agrees and certifies with respect to the grant that:
1. It possesses legal authority to apply for the grant; that
a resolution, motion or similar action has been duly
adopted or passed as an official act of the applicant's
governing body, authorizing the filing of the applica-
tion, incTadTng all understandings and assurances
contained therein, and directing and authorizing the
person identified as the official representative of the
applicant to act in connection with the application and
8. It will give the grantor agency and the Comptroller
General through any authorized representative the
access to and the right to examine all records, books,
papers, or documents related to the grant.
9.
to provide such additional information as may be
required.
2. It will comply with Title VI of the Civil Rights Act of 1964
(P.L. 88-352) and in accordance with Title VI of that
Act, no person in the United States shall, on the ground
of race, color, or nation origin, be excluded from
participation in, be denied the benefits of, or be
otherwise subjected to discrimination under any pro-
gram or activity for which the applicant receives
Federal financial assistance and will immediately take
any measures necessary to effectuate this agreement.
3. It will comply with Title VI of the Civil Rights Act of 1964
(42 DSC 2000d) prohibiting employment discrimina-
tion where (1) the primary source of a grant is to
provide employment or (2) discriminatory employment
practices will result in unequal treatment of persons
who are or should be benefiting from the grant-aided
activity.
4. It will comply with requirements of the provisions of the
Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (P.L. 91-646) which provides
for fair and equitable treatment of persons displaced
as a result of Federal and federally assisted programs.
5. It will comply with the provisions of the Hatch Act which
limit the political activity of employees.
6. It win comply with the minimum wage and maximum
hours provisions of the Federal Fair Labor Standards
Act, as they apply to employees of institutions of higher
education, hospitals, other non-profit organizations,
and to employees of State and local governments who
are not employed In integral operations in areas of
traditional governmental functions.
7. tt win establish safeguards to prohibit employees from
using their positions for a purpose that is or gives the
appearance of being motivated by a desire for private
gain for themselves or others, particularly those with
whom they have family, business, or other ties.
It will comply with all requirements imposed by the
Federal grantor agency concerning special require-
ments of law, program requirements, and other ad-
ministrative requirements.
11.
10. It will insure that the facilities under its ownership,
lease or supervision which shall be utilized in the
accomplishment of the project are not listed on the
Environmental Protection Agency's (EPA) list of Violat-
ing Facilities and that it will notify the Federal grantor
agency of the receipt of any communication from the
Director of the EPA Office of Federal Activities indicat-
ing that a facility to be used in the project is under
consideration for listing by the EPA.
It will comply with the flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1573, Public Law 93-234, 87 Slat.
975, approved De.jmber 31, 1976. Section 102(a)
requires, on and after March 2, 1975, the purchase of
flood insurance in communities where such insurance
is available as a condition for the receipt of any Federal
financial assistance for construction or acquisition
purposes for use in any area that has been identified
by the Secretary of the Department of Housing and
Urban Development as an area having special flood
hazards.
It will comply with all applicable requirements of
Section 13 of the Clean Water Act Amendments of
1972 (P.L. 92-500), if the grant is awarded under any
grant authority of that Act, which provides that no
person in the United States shall, on the ground of sex
be excluded from participation in, be denied the
benefits of, or be otherwise subject to discrimination
under any program or activity under the said Clean
Water Act Amendments for which the applicant re-
ceives financial assistance and will take all necessary
measures to effectuate this agreement.
12.
EPA Form 5700-33 (Rev. 11-86)
SAMPLE GRANT APPLICATION - Page 16 of 16
-------
Sample Application Documents I -63
Procurement System Certification
(EPA Form 5700-48)
[To be submitted with application]
-------
1-64
-------
Sample Application Documents 1 -65
&EPA
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460
PROCUREMENT SYSTEM CERTIFICATION
APPLICANT'S NAME
Woodtown Landfill Coalition
Form Approved
OMB No 2000-0453
Approval expires 1 0-31 -87
ASSISTANCE APPLICATION NUMBER
APPLICANT'S ADDRESS
Main Street
Woodtown, CT 06898
SECTION I — INSTRUCTIONS
The applicant must complete and submit a copy of this form with each application for EPA Assistance. If the
applicant has certified its procurement system to EPA within the past 2 years and the system has not been
substantially revised, complete Part A in Section II, then sign and date the form. If the system has not been
certified within the past 2 years, complete Part B, then sign and date the form.
SECTION II — CERTIFICATION
A. I affirm that the applicant has within the past 2 years certified to EPA that its procurement
system complies with 40 CFR Part 33 and that the system meets the requirements in 40
CFR Part 33. The date of the applicant's latest certification is:
MONTH/YEAR
B. Based upon my evaluation of the applicant's procurement system, I, as authorized representative of the
applicant: (Check one of the following:)
LJ 1. CERTIFY that the applicant's procurement system will meet all of the requirements of 40 CFR Part 33
before undertaking any procurement action with EPA assistance
Please furnish citations to applicable procurement ordinances and regulations
2. DO NOT CERTIFY THE APPLICANT'S PROCUREMENT SYSTEM. The applicant agrees to
follow the requirements of 40 CFR Part 33, including the procedures in Appendix A, and
allow EPA preaward review of proposed procurement actions that will use EPA assistance.
TYPED NAME AND TITLE
Pat Jones
T)i'rpni"nr
SIGNATURE
DATE
07/10/90
EPA Form 5700-48 (Rev. 5-84) Previous edition is obsolete
-------
Sample Application Documents 1 "67
Certification Regarding Debarment, Suspension,
and Other Responsibility Matters
(EPA Form 5700-49)
[To be submitted with application]
-------
Sample Application Documents 1 -69
EPA Project Control Number
United State* Environmental Protection Agency
Washington. DC 20460
Certification Regarding
Debarment, Suspension, and Other Responsibility Matters
The prospective participant certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) Have not within a three year period preceding this proposal been convicted of or had a civil judgement
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving
stolen property,
(c) Are not presently indicted for or otherwise criminally or dvflly charged by a government entity (Federal,
State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification; and
(d) Have not within a three-year period preceding this application/proposal had one or more public
transactions (Federal, State, or local) terminated for cause or default
I understand that a false statement on this certification may be grounds for rejection of this proposal or
termination of the award. In addition, under 18 USC Sec. 1001, a raise statement may result in a fine of up
to $10,000 or imprisonment for up to 5 years, or both.
Woodtown Landfill Coalition, Pat Jones, Executive Director
Typed Nam* & rite of Authorized Representative
07/10/90
LJ I am unable to certify to the above statements. My explanation is attached.
EPA Form 5700-4* (114ft?
-------
1-71
. * : *
TAG Application Checklist
" .?, *~ i* ",- ^'*/v#F-asr*;~^ 5 ir* *:?*,
Q Submit a Letter of Intent. (EPA will then publish a public notice informing
other groups of your intent to apply as well.)
Q Read the Superfund Technical Assistance Grant (TAG) Handbook 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 applications separately.
Qj Contact the appropriate state office (see "References" section for list of state
offices) to determine the intergovernmental review requirements for your state.
DO THIS EARLY.
Q Complete the grant application package:
• The grant application form, "State and Local Nonconstruction Programs,"
(EPA Form 5700-33).
• "Procurement System Certification," (EPA Form 5700-48).
• "Certification Regarding Debarment, Suspension, and Other Responsibility
Matters," [EPA Form 5700-49 (11-88)], if your group seeks a grant of $25,000
or more.
Q Submit your application for intergovernmental review if necessary.
Q Send the original version of your completed and signed grant application,
and two copies, to your EPA Regional Office while the intergovernmental
review process is being completed. (See "References" section for list of EPA
Regional Offices).
Q If the grant is awarded, sign and return the grant agreement to EPA within
three calendar weeks.
Q If necessary, file the appropriate documents for incorporation with the proper
state agency upon receipt of notification of award and prior to signing the
grant agreement.
April 1990
-------
1-73
Blank Application Documents
In this section you will find blank copies of each document you will need to fill
out to complete your TAG application. While these are standard federal grant forms,
EPA has developed instructions specifically for TAG applicants to use in completing
these forms. Pages 1 -15 through 1 -69 of Part 1 contain step-by-step instructions
for completing the grant application as well as sample completed versions of these
documents. Wherever questions on these forms call for standard answers by TAG
applicants, EPA has supplied the correct response to simplify the application
process for you. Documents you will find in this section include:
• Application For Federal Assistance
{Standard Form 424; EPA Form 5700-33 (rev. 11-86)];
• Procurement System Certification (EPA Form 5700-48); and
• Certification Regarding Debarment, Suspension, and Other Responsibility
Matters (EPA Form 5700-49).
April 1990
-------
Blank Application Documents 1-T5
The Application for Federal Assistance
[EPA Form 5700-33 (Rev. 11-86), Standard Form 424]
-------
Blank Application Documents 1 -77
FEDERAL ASSISTANCE
D NOTICE OF INTENT (OPTIONAL)
1. TYPE
OF
SUBMISSION ,_.
(Mark of U PREAPPUCATION
£*•** 03 APPLICATION
box)
2. APPU-
CANTS
APPLI-
CATION
IDENTI-
FIER
a. NUMBER
b DATE
Year month day
19
3.' STATE
APPLI-
CATION
IDENTI-
FIER
AWX- TO BE
ASSIGNED
BY STATE
. NUMBER
b. DATE
ASSIGNED
Year month day
19
Blank
4. LEGAL APPLICANT/RECIPIENT
a. Applicant Nama
b. Organization Unit
c. StrMt/P.O. Box
d. City
f. State
h. Contact Parton (Name
A Telephone No.)
9. County
g. ZIP Cod*.
7. TITLE OF APPLICANTS PROJECT (UM saction IV of this form to provxJa « summary daacnptton of tha
project)
Technical Assistance at:
5. EMPLOYER IDENTIFICATION NUMBER (EIN)
6.
PRO-
GRAM
(From CFDA)
a. NUMBER
6 [6 | ' | 8 |0 | 6 .
MULTIPLE G
b. TITLE Superf und TecKnical
Assistance Grant
8. TYPE OF APPLICANT/RECIPIENT
H—ConwMWy Acfcn Agency
V-HlgMr Educrtond InWMon
0-Court»
E-Ot,
K-O»» (Sftctfyl.
Enter appropr jte letter \ ]( I
i I
Non-Profit Citizen Organization
9. AREA OF PROJECT IMPACT (Nama ofcitia. counties, states, etc.)
10. ESTIMATED NUMBER
OF PERSONS BENEFITING
11. TYPE OF ASSISTANCE
0—tmum*
>- I A I I
'^ I A | |
12.
PROPOSED FUNDING
.FEDERAL
b. APPLICANT
STATE
d. LOCAL
e. OTHER
Total
.00
.00
.00
JJO
.00
13.
CONGRESSIONAL DISTRICTS OF:
a APPLICANT
IS. PROJECT START
DATE
Year month dav
19
14. TYPE OF APPLICATION
k >!»»
b. PROJECT
p. n.m«M) 0-Con*t«*on
Enter appropriate Imer
1C. PROJECT
DURATION
17. TYP6 OF CHANGE (Far 14c or Hti
* mn»«pi (Mm F-Otm (Specify)
t-Ovnm* OaHn
C—mawM amkm
18. DATE DUE TO
FEDERAL AGENCY i
19
Year month day
Enter appro-
pntte letterfsl
19. FEDERAL AGENCY TO RECEIVE REQUEST
a. ORGANIZATIONAL UNIT (IF APPROPRIATE)
b. ADMINISTRATIVE CONTACT (IF KNOWN)
20. EXISTING FEDERAL GRANT
IDENTIFICATION NUMBER
c. ADDRESS
21. REMARKS ADDED
No
22.
THE
APPLICANT
CERTIFIES
THAT*
To th« b«*t o» my knowtodg* and t>^W,
data in tt*a pr*appticatton/app»ication
am tnM and oonwct, th« documant haa
ba«n duly authorizad by tha govamlng
body of tt>^ tppKctnt tnd
wiN comply wtth tha attacnad
« ttw •oittanc* is approved.
a. YES, THIS NOTICE OF INTENT/PREAPPUCATION/APPLICATION WAS MADE AVAILABLE TO THE STATE
EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
DATE
b. NO. PROGRAM IS NOT COVERED BY E.O. 12372 D
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW D
23.
CERTIFYING
REPRE-
SENTATIVE
TYPED NAME AND TITLE
b. SIGNATURE
24. APPLICA-
TION
RECEIVED 10
Year motiln day
25. FEDERAL APPLICATION IDENTIFICATION NUMBER
26. FEDERAL GRANT IDENTIFICATION
27. ACTION TAKEN
O a. AWARDED
O b. REJECTED
Q c. RETURNED FOR
AMENDMENT
O d RETURNED FOR
E.O. 12372 SUBMISSION
BY APPLICANT TO
STATE
O a. DEFERRED
Of. WITHDRAWN
26.
FUNDING
a. FEDERAL
b. APPLICANT
c. STATE
6. LOCAL
«. OTHER
f.
TOTAL
.00
.00
.00
.00
.00
.00
Year month day
29. ACTION DATE*-
19
31. CONTACT FOR ADDITIONAL INFORMA-
TION (Name and telephone, number)
30.
STARTING
DATE
Year month dati
19
32.
ENDING
DATE
Ytar month dat
19
33. REMARKS ADDED
D
YM
D
No
EPA Form 5700-33 (Rev. n-86) GRANT APPLICATION - Page 1 of 16
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1 -78 Blank Application Documents
SECTION IV-REMARKS fW*w* rtftnnc* f/»proper itum numb* from Stctiont I, II or til, if tpplicublt)
EPA Form 5700-33 (Rev. 1 1-86}
GRANT APPLICATION - Page 2 of 16
-------
Blank Application Documents 1 -79
PART II
PROJECT APPROVAL INFORMATION
Form Approved
OMB No 2030-CC2C
Approval expires 7-3" -39
Item 1.
Does this assistance request State, local, regional, or other priority
rating?
Yes X No
Name of Governing Body .
Priority Rating
Item 2.
Does this assistance request require State or local advisory, edu-
cational, or health clearances?
.Yes
.No
Name of Agency or
Board
(Attach Documentation)
Item 3.
Does this assistance request require clearinghouse review in ac-
cordance with Executive Order 12372?
Yes
.No
(Attach Comments)
lt»m 4.
Does this assistance request require State, local, regional or other
planning aporoval?
X
Yes No
Name of Approving Agency.
Date
ltf>m 5.
Is the proposed project covered by an approved comprehensive
plan?
X
.Yes
, No
Check one: State D
Local D
Regional D
Location of Plan
Item 6.
Will the assistance requested serve a Federal installation?
Yes
No
Name of Federal Installation
Federal Population benefiting from Project
lt«m 7.
Will the assistance requested be on Federal land or installation?
-Yes
.No
Name of Federal Installation .
Location of Federal Land
Percent of Project
'turn 8.
Will ,he assistance requested have an impact or effect on the
environment?
X
.Yes
.No
See instructions for additional information to be provided.
This assistance is intended to
facilitate site response actions.
item 9.
Has the project for which assistance is requested caused, since
January 1. 1971, or will it cause, the displacement of any individual,
family, business, or farm?
.Yes
.No
Number of:
Individuals.
Families
8usmesses_
Farms
Itei.i 10.
Is there other related assistance on this project previous, pending,
or entic.peted?
See instructions for additional information to be provided.
.Yes
.No
K«n 11.
l» project in a Designated Flood Hazard Area7
-Ye.
-No
EPA Fcrrrs 5700-33 (Rev. 11-86)
GRANT APPLICATION - Page 3 of 16
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1 -80 Blank Application Documents
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GRANT APPLICATION - Page 4 of 16
-------
Blank Application Documents I "O I
SECTION B - SCHEDULE B - BUDGET CATEGORIES
6. Program Elements
a Technical Assistance at:
b.
c
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e.
f.
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i. Total Program Elements
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EPA Form 57OO-33 (Rev. 11-86)
GRANT APPLICATION - Page 5 of 16
-------
I "82 Blank Application Documents
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Blank Application Documents 1 "83
PART IV - Narrative Project Statement
Part IV consists of two sections. The first section, "Group Qualifications," is used by EPA to
obtain information about your group's eligibility, characteristics, and plans for using grant funds.
The second section of Part IV is the Narrative Statement of Work for the technical advisor(s).
In this section, your group describes how a grant award would be used with respect to
Superfund technical milestones (for example, review of the Remedial Investigation Report) and
provides your proposed budget.
To help determine projected tasks for your advisor and a tentative schedule in preparing the
Statement of Work, you are encouraged to review the pamphlets on the Superfund and TAG
Programs and the fact sheet entitled "Summary of Public Documents Prepared During the
Remedial Process" that accompany this handbook. Also, review the Introduction to this
handbook, which discusses the role of the technical advisor(s) and the sample application in
the "Sample Documents" section of Part 1. For each task indicated in the Statement of Work,
you will need to estimate the amount of review time to be allotted to your technical advisor(s).
Section 1 (Group Qualifications)
A. Group Eligibility
1. Is your group part of any of the following organizations? If the answer is yes,
check the categories below that apply.
Potentially Responsible Parties;
Academic Institutions;
Political Subdivisions (e.g., townships and municipalities; or local
government); and
Groups established and/or sustained by a state or local government.
GRANT APPLICATION - Page 7 of 16
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1 "84 Blank Application Documents
PART IV - Narrative Project Statement (continued)
2. How many members are in your group? Is it made up of a coalition of
groups? (yes/no) If so, how many, and how did the groups come together?
If not, how was your group formed?
B. Responsibility Requirements
1. Administrative and Management Capabilities: Please briefly describe the
organizational structure of your group in the space below. (Describe roles and
responsibilities of members, particularly members who will be responsible for
financial management of the grant and directing the activities of the technical
advisor.)
GRANT APPLICATION - Page 8 of 16
-------
Blank Application Documents 1 "85
PART IV - Narrative Project Statement (continued)
2. Resources for Project Completion: What resources are available to your group
to help complete the TAG Project? (Include any plans that your group has for in-
kind contributions or for fund raising and obtaining cash.)
3. Performance Record: Please describe your group's past performance with
satisfactorily completing projects and contracts. (If your group has no past
experience, EPA will evaluate the description, budget, and schedule you provide
in Part IV, Section 2, of this application.)
GRANT APPLICATION - Page 9 of 16
-------
1 "86 Blank Application Documents
PART IV - Narrative Project Statement (continued)
4. Accounting and Auditing Procedures: What procedures does your group plan
to use for recordkeeping and financial accountability related to the grant? Please
identify the member of your group who will maintain your financial records.
GRANT APPLICATION - Page 10 of 16
-------
Blank Application Documents 1 "87
PART IV - Narrative Project Statement (continued)
5. Incorporation: Is your group incorporated specifically for the purpose of
addressing problems at this site? (yes/no) If not, what steps is your group
taking to incorporate for grant-related purposes?
6. Does your group have a substantial history of involvement at the site?
(yes/no) (If so, please include a brief description of your group's involvement.)
7. Drug-Free Workplace Policy: Does your group promise not to engage in illegal
drug-related activities while carrying out activities using TAG funds? (yes/no)
GRANT APPLICATION - Page 11 of 16
-------
I -88 Blank Application Documents
PART IV - Narrative Project Statement (continued)
C. Group Issues and Objectives
1. Health Considerations: How many group members have experienced health
effects from contamination at the site? Describe actual or potential health
threats the site poses to individual group members and the efforts members of your
group have undertaken to resolve or make known these health concerns.
2. Consolidation/Representation: Describe the number and diversity of affected
community organizations and individuals represented by your group, highlighting
the ways in which your group represents affected individuals affected by the site.
GRANT APPLICATION - Page 12 of 16
-------
Blank Application Documents 1 -89
PART IV - Narrative Project Statement (continued)
3. Tasks for Technical Advisors: Please describe how your group intends to use
your technical advisor to interpret technical Superfund information.
4. Information Sharing: How does your group intend to share information collected
with grant funds with the larger community?
GRANT APPLICATION - Page 13 of 16
-------
I "90 Blank Application Documents
PART IV - Narrative Project Statement (continued)
5. Economic/Environmental Considerations: How many group members have
experienced economic/environmental impacts from contamination at the site?
Please describe the actual or potential economic harm or loss of environmental
amenities the site has imposed on individual group members, and efforts group
members have undertaken to resolve or make known these concerns.
Section 2 - Narrative Statement of Work for the Technical Advisor
A. Statement of Work: Please identify the technical advisor(s)' tasks for each phase of the
Superfund process. For each of these phases, please note what the technical advisor
will do, the estimated amount of time needed to complete each task, and specific docu-
ments, reports, or other tangible work products you expect the technical advisor to
produce. (See Attachments 1 .A. and 1 .B. in the Sample Grant Application for one way
of doing this.)
GRANT APPLICATION - Page 14 of 16
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Blank Application Documents 1-91
PART IV - Narrative Project Statement (continued)
B. Detailed Budget: Prepare a budget for the technical assistance project. Indicate the
tasks to be completed by the technical advisor, the estimated number of hours, and the
cost for each task (including travel costs). Use footnotes to explain assumptions made
in the budget (such as hourly rate of advisor or adjustments for inflation). This budget
should identify everything that you expect to purchase with grant funds.
This budget should show the amount of the group's matching contribution separately
from federal funds. (See Attachment 1 .C. in the Sample Grant Application for one way
of doing this.) Note that the grant funds (usually 80 percent) plus group contribution
(usually 20 percent) must equal the total project costs; grant funds cannot exceed 80
percent of project costs for any budget period. In your statement, be sure that you
differentiate cash expenditures from in-kind contributions. Also include explanations of
the assumptions made in calculating the value of in-kind contributions.
As discussed on pages 1 -24, 1 -25, and in Part 3, goods or services not identified in this
budget, which you later want to accept or purchase, will require written approval from
EPA. This includes goods and services in the matching share.
GRANT APPLICATION - Page 15 of 16
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1 -92 Blank Application Documents
NOTE: Be sure to have your group's project manager sign and date the bottom of this form
and give his or her title.
PARTV
ASSURANCES
The Applicant agrees and certifies that he or she will comply with the regulations, policies, guidelines, and
requirements, including OMB Circulars No. A-102 and A-87, and Executive Order 12372, as they relate to
the application, acceptance, and use of Federal funds for this Federally assisted project. Also, the Appli-
cant agrees and certifies with respect to the grant that:
1. It possesses legal authority to apply for the grant; that
a resolution, motion or similar action has been duly
adopted or passed as an official act of the applicant's
governing body, authorizing the filing of the applica-
tion, inctudmg all understandings and assurances
contained therein, and directing and authorizing the
person identified as the official representative of the
applicant to act in connection with the application and
to provide such additional information as may be
required.
2. It will comply with Title VI of the Civil Rights Act of 1964
(P.L. 88-352) and in accordance with Title VI of that
Act, no person in the United States shall, on the ground
of race, color, or nation origin, be excluded from
participation in, be denied the benefits of, or be
otherwise subjected to discrimination under any pro-
gram or activity for which the applicant receives
Federal financial assistance and will immediately take
any measures necessary to effectuate this agreement.
3. It will comply with Title VI of the Civil Rights Act of 1964
(42 USC 2000d) prohibiting employment discrimina-
tion where (1) the primary source of a grant is to
provide employment or (2) discriminatory employment
practices will result in unequal treatment of persons
who are or should be benefiting from the grant-aided
activity.
4. It will comply with requirements of the provisions of the
Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (P.L. 91-646) which provides
for fair and equitable treatment of persons displaced
as a result of Federal and federally assisted programs.
5. It will comply with the provisions of the Hatch Act which
limit the political activity of employees.
6. It wiH comply with the minimum wage and maximum
hours provisions of the Federal Fair Labor Standards
Act, as they apply to employees of institutions of higher
education, hospitals, other non-profit organizations,
and to employees of State and local governments who
are not employed in integral operations in areas of
traditional governmental functions.
7. It win establish safeguards to prohibit employees from
using their positions for a purpose that is or gives the
appearance of being motivated by a desire for private
gain for themselves or others, particularly those with
whom they have family, business, or other ties.
8. It will give the grantor agency and the Comptroller
General through any authorized representative the
access to and the right to examine all records, books,
papers, or documents related to the grant.
9. It will comply with all requirements imposed by the
Federal grantor agency concerning special require-
ments of law, program requirements, and other ad-
ministrative requirements.
10. It will insure that the facilities under its ownership,
lease or supervision which shall be utilized in the
accomplishment of the project are not listed on the
Environmental Protection Agency's (EPA) list of Violat-
ing Facilities and that it will notify the Federal grantor
agency of the receipt of any communication from the
Director of the EPA Office of Federal Activities indicat-
ing that a facility to be used in the project is under
consideration for listing by the EPA.
11. It will comply with the flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973, Public Law 93-234, 87 Slat.
975, approved De:^mber 31, 1976. Section 102(a)
requires, on and after March 2,1975, the purchase of
flood insurance in communities where such insurance
is available as a condition for the receipt of any Federal
financial assistance for construction or acquisition
purposes for use in any area that has been identified
by the Secretary of the Department of Housing and
Urban Development as an area having special flood
hazards.
12. It will comply with all applicable requirements of
Section 13 of the Clean Water Act Amendments of
1972 (P.L. 92-500), if the grant is awarded under any
grant authority of that Act, which provides that no
person in the United States shall, on the ground of sex
be excluded from participation in, be denied the
benefits of, or be otherwise subject to discrimination
under any program or activity under the said Clean
Water Act Amendments for which the applicant re-
ceives financial assistance and will take all necessary
measures to effectuate this agreement.
EPA Form 5700-33 (Rev. 11-86>
GRANT APPLICATION - Page 16 of 16
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Blank Application Documents I "93
Procurement System Certification
(EPA Form 5700-48)
-------
Blank Application Documents 1 "95
vvEPA
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460
PROCUREMENT SYSTEM CERTIFICATION
APPLICANT'S NAME
Form Approved
OMB No 2000-0453
Approval expires 10-31-87
ASSISTANCE APPLICATION NUMBER
APPLICANT'S ADDRESS
SECTION I — INSTRUCTIONS
The applicant must complete and submit a copy of this form with each application for EPA Assistance. If the
applicant has certified its procurement system to EPA within the past 2 years and the system has not been
substantially revised, complete Part A in Section II, then sign and date the form. If the system has not been
certified within the past 2 years, complete Part B, then sign and date the form.
SECTION II - CERTIFICATION
A. I affirm that the applicant has within the past 2 years certified to EPA that its procurement
system complies with 40 CFR Part 33 and that the system meets the requirements in 40
CFR Part 33. The date of the applicant's latest certification is:
MONTH/YEAR
B. Based upon my evaluation of the applicant's procurement system, I, as authorized representative of the
applicant: (Check one of the following:)
LJ 1. CERTIFY that the applicant's procurement system will meet all of the requirements of 40 CFR Part 33
before undertaking any procurement action with EPA assistance
Please furnish citations to applicable procurement ordinances and regulations
LJ2. DO NOT CERTIFY THE APPLICANT'S PROCUREMENT SYSTEM. The applicant agrees to
follow the requirements of 40 CFR Part 33, including the procedures in Appendix A, and
allow EPA preaward review of proposed procurement actions that will use EPA assistance.
TYPED NAME AND TITLE
SIGNATURE
DATE
EPA Form 5700-48 (Rev. 5-84) Previous edition is obsolete.
-------
Blank Application Documents 1-9T
Certification Regarding Debarment, Suspension,
and Other Responsibility Matters
(EPA Form 5700-49)
-------
Blank Application Documents 1 -99
EPA Project Control Number
United State* Environmental Protection Agency
Washington. DC 20460
Certification Regarding
Debarment, Suspension, and Other Responsibility Matters
The prospective participant certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) Have not within a three year period preceding this proposal been convicted of or had a civil judgement
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving
stolen property,
(c) Are not presently indicted for or otherwise criminally or dvflly charged by a government entity (Federal,
State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification; and
(d) Have not within a three-year period preceding this application/proposal had one or more public
transactions (Federal. State, or local) terminated lor cause or default
I understand that a false statement on this certification may be grounds for rejection of this proposal or
termination of the award. In addition, under 18 USC Sec. 1001, a raise statement may result in a fine of up
to $10,000 or imprisonment for up to 5 years, or both.
Typed Hunt & Titto of Authorized fte
SiQnfltw of AuflHofiMd
LJ I am unable to certify to the above statements. My explanation is attached.
EPA Form S700-W
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