United States
Environmental Protection
Agency
Office of
Research and Development
Washington, D.C. 20460
EPA/600/F-95/003a
March 1995
«r EPA UNITED STATES
ENVIRONMENTAL PROTECTION AGENCY
APPLICATION KIT
FOR ASSISTANCE
i
Printed on Recycled Paper
-------
-------
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON. D.C. 20460
Of FCC OF
ADMINISTRATION
nAav »~~i .; „„„.!-. ANDRESOUCES
Dear Applicant: MANAGEMENT
Attached is an application kit for submitting a proposal to
the Environmental Protection Agency for federal assistance. In
order to assist you in completing your application, we have
developed a list of items in the application kit and a brief
description of each. We also have included a check list of items
that must be submitted in order to make your submission complete.
Before you mail your application, please be sure it is complete.
Our mailing address is included in the application kit for your
convenience. Also, the page entitled "Key Contacts" is very
important to ensure that we work with the proper individuals in
your organization.
You need to consider whether your proposal is for acquisition
or assistance. The 8F 424 is only used for submitting proposals
for federal assistance. The Federal Grant and Cooperative
Agreement Act requires Federal agencies to use a contract to
acquire property or services for the direct benefit of the Federal
government, and a grant or cooperative agreement to transfer money,
property, services, or anything else of value to support or
stimulate an activity to accomplish a public purpose of assistance
•authorized by Federal statute.
The determining factor in choosing acquisition versus
assistance is defining the direct beneficiary.. If the direct
beneficiary is a State or local government or other recipient, and
the purpose of support or stimulation is authorized by Federal
statute, then a grant or cooperative agreement is the proper legal
instrument to use. If the direct beneficiary is EPA, then a
contract is the appropriate legal instrument to use and the
submission of SF 424 is inappropriate.
If you have any questions about completing your application or
have general inquiries about EPA's assistance programs, please feel
free to contact my staff on area code (202) 260-9266.
Sincerely,
. .
Mildred Lee, Chief
Grants Operations Branch
Grants Administration Division (PM-216F)
Printed on Recycled Paper
-------
-------
ITEMS IN YOUR APPLICATION KIT
APPLICABLE EPA REGULATIONS
DESCRIPTION OF EPA REGULATIONS
HELPFUL HINTS
SUPPLEMENTAL INFORMATION:
APPLICATION FOR FEDERAL ASSISTANCE
(STANDARD FORM 424)
ADDITIONAL TIPS FOR COMPLETING THE SF-424
CHECKLIST OF APPLICATION ITEMS TO BE SUBMITTED
APPLICATION RECEIPT LETTER
KEY CONTACTS
SF-424, "APPLICATION FOR FEDERAL ASSISTANCE",
INCLUDING INSTRUCTIONS AND ASSURANCES,
SF 424A AND SF 424B
PROCUREMENT SYSTEM CERTIFICATION
I
CERTIFICATION REGARDING DEBARMENT
AND SUSPENSION
CERTIFICATION REGARDING LOBBYING, INCLUDING
DISCLOSURE OF LOBBYING ACTIVITIES
EPA MAILING ADDRESS
-------
APPLICABLE EPA REGULATIONS
available upon request; call (202) 260-9266
(Your business office may have copies of these regulations.
Please check with them first)
A. STATE and LOCAL GOVERNMENTS and INDIAN TRIBAL GOVERNMENTS
Part 31 - Uniform Administrative Requirements for Grants &
Cooperative Agreements to States & Local Governments
Part? - Nondlscrlmlnatlon In Programs Receiving Federal
Assistance from the Environmental Protection Agency
Part 12 - Nondlscrlmlnatlon on the Basis of Handicap In Programs
or Activities Conducted by the Environmental Protection Agency
Part 32 - Government-wide Debarment and Suspension (Nonprocurement)
and Government-wide Requirements for Drug-Free
Workplace (Grants)
Part 29 - Intergovernmental Review of Environmental Protection
Agency Programs and Activities
Instructions to Applicants - Intergovernmental Review Procedures
and List of Single Point of Contacts
Part 34 - New Restrictions on Lobbying
B. FOR ALL OTHER TYPES OF APPLICANTS
Part 30 - General Regulations for Assistance Programs
Part 33 - Procurement Under Assistance Agreements
Part 7 - See Above
Part 12 - See Above
Part 32 - See Above
Part 29 - See Above
Part 34 - See Above
-------
DESCRIPTION OF EPA REGULATIONS
PART 30 - GENERAL REGULATION FOR ASSISTANCE PROGRAMS
This regulation applies to all EPA applicants except State
Local and Indian Tribal governments. '
If the regulation applies to you, you are required to be
familiar with it and to comply with its provisions.
PART 31 - UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND
COOPERATIVE AGREEMENTS TO STATE AND LOCAL GOVERNMENTS
State, Local and Indian Tribal governments are required to be
familiar with this regulation and to comply with its provisions.
PART 32 - DEBARMENT AND SUSPENSION UNDER EPA ASSISTANCE, LOANS
AND BENEFIT PROGRAMS
All applicants are required to be familiar with the regulation
and to submit the certification with their application. In
addition, recipients are required to obtain the certification from
subrecipients receiving $25,000 or more.
PART 33 - PROCUREMENT UNDER ASSISTANCE AGREEMENTS AND THE
PROCUREMENT SYSTEM CERTIFICATION
The "Part 33 - Procurement under Assistance Agreements"
applies to all EPA applicants except State, Local amd Indian Tribal
governments.
If the regulation applies to you, you are required to be
familiar with it and to comply with its provisions. In addition,
you are required to complete the "Procurement System
Certification".
State governments do not need to self-certify.
PART 34 - NEW RESTRICTIONS ON LOBBYING
All applicants requesting $100,000 or more from EPA must
submit the "Certification Regarding Lobbying" and, if appropriate,
complete the "Disclosure of Lobbying Activities". Please note that
contractors receiving subagreements of $100,000 or more are also
required to certify and disclose to the individual or organization
awarding the subagreement.
-------
PART 29 - INTERGOVERNMENTAL REVIEW PROCEDURES
The EPA program for which you are applying may be subject to
your State's Intergovernmental review process and or the
consultation requirements of Section 204, Demonstration Cities and
Metropolitan Development Act. You must contact your State's single
point of contact to find out if the program was selected for
coverage by the State process and, if the program was selected, to
receive information about your State's review process requirements
and procedures. If you do not know who your Single Point of Contact
is, please call (202) 260-9266. If the program in which you are
applying is subject to Section 204, you must notify areawide
metropolitan or regional planning agencies and/or general
government units authorized to govern planning for the locale of
your project.
PARTS 7 and 12 - NONDISCRIMINATION IN PROGRAMS RECEIVING FEDERAL
ASSISTANCE PROM THE ENVIRONMENTAL PROTECTION AGENCY - FINAL RULE
These rules implement the statutes prohibiting discrimination
on the grounds of race, color, national origin, sex and handicap.
All applicants for EPA assistance are required to be familiar with
these rules and to comply with their provisions.
-------
HELPFUL HINTS
APPLICATION FOR FEDERAL ASSISTANCE (STANDARD FORM 424.
STANDARD FORM 424A. AND STANDARD FORM 424B)
Based on the inquiries we frequently receive, we have
developed the following information augmenting the
instructions in the "Application for Federal Assistance"
(Standard Form 424). Reading this information in conjunction
with the instructions in the application form will speed up
the preparation of your application and will reduce our
processing time on your application.
I
The application is divided into three parts:
(1) the "Application for Federal Assistance" (Standard
Form 424) with accompanying instructions;
(2) the "Budget Information -Non-Construction Programs"
(Standard Form 424A) with accompanying instructions; and
(3) the "Assurances -Non-Construction Programs"
(Standard Form 424B). !
-------
-------
SUPPLEMENTAL INFORMATION:
APPLICATION FOR FEDERAL ASSISTANCE (STANDARD FORM 424)
Please refer to the instructions for SF 424. The items that
require special attention are discussed below.
ITEM 5: If the "Name and telephone number of the person to be
contacted for matters involving this application" is different from
that of the Project Manager, i.e., the person who will be our
contact for technical matters if the application is funded, please
provide the name, title, address and telephone number of the
Project Manager on the key contact list.
In addition, please submit a biographical sketch of the
Project Manager incorporating information on education,, background,
and other qualifying experience for the project. Also list the
name and training or discipline of other key personnel engaged in
the project. Identify other projects in which the Project Manager
is engaged and the amount of time he or she devotes to each.
Provide a summary of employment, including contracts and
consultancies, for the present and for the past two years for the
Project Manager and each of the key personnel.
ITEM 9: Please insert the name, if applicable, of the EPA
person(s) from whom you have received preapplication assistance.
This information assists us in routing your application to the
appropriate EPA office for review.
ITEM 10: Insert the Catalog of Federal Domestic Assistance
Number and Title, if known. ;
ITEM 13: The "Start Date" and "Ending Date" should reflect
the amount of time that will be required to complete the entire
scope of work in your application (i.e., the "project period").
However, in accordance with our regulations and administrative
procedures, your project period may be divided into a series of
"budget periods". The definitions of a project period and a budget
period are as follows: .Project Period; The length of time EPA
specifies in the assistance agreement for completion of all project
work. It may be composed of more than one budget period. Budget
Period: The length of time EPA specifies in an assistance
agreement during which the recipient may expend or obligate Federal
funds. The guidance provided below for completing the budget
instructs you to give the dates for each budget period,.
ITEM 15: The amounts under "Estimated Funding" are the
amounts requested or to be contributed during the first budget
period.
ITEM 18: If EPA awards a grant or cooperative agreement
pursuant to your application, we will mail the official copies of
the award agreement to the authorized representative listed in Item
18.
-------
DESCRIPTION OF PROJECT: Your application should include a
section that provides the following information:
* Objective: Describe the principal and subordinate
objectives of the project. Pinpoint any relevant physical,
economic, social, financial, institutional, or other problems
requiring solution. Supporting documents from concerned interests
other than the applicant may be used. Any relevant data based on
planning studies should be included and footnoted.
* Results or benefits expected: Identify results and/or
benefits accruing to the project. [Important: Include all primary
and secondary benefits accruing to the recipient, the population
served/ the public and the environment in general]; for example:
compliance with water quality standards or ambient air quality
standards, advancements in the state of the art of pollution
abatement, etc.
* Approach:
a. Provide a detailed work plan for the accomplishment of the
scope and detail of the proposed project. Cite factors that might
accelerate or decelerate the work. Indicate why this approach has
been taken rather than alternatives. Describe any unusual features
of the project such as design or technological innovations,
reductions in cost or time or extraordinary social and community
involvement.
b. Describe all facilities presently available for use in
carrying out the project.
c. For all applications list by name all non-Federal sources
of funds and facilities to be utilized in the performance of the
proposed project.
d. List in chronological order a schedule of accomplishments,
progress, or milestones that are anticipated over the length of the
project.
e. Indicate by whom each element of the work plan will be
carried out including supporting agencies, consultants and
contractors.
f. Describe sampling and data collection procedures,
analytical methods, and methods for evaluating the results of the
project.
-------
* General Project Information:
a. Identify the kinds of data to be collected (and
maintained) and discuss the criteria to be used to evaluate the
results and successes of the project. Indicate vhethor research or
demonstration will involve human subjects or research animals.
b. Discuss: (1) the effect of this project on or its
relationship to other work planned, anticipated, or underway by the
grantee, recipient of the funds, or other Government agencies; (2)
Federal, State, interstate, and local programs with which the work
will be coordinated and the extent and nature of the coordination.
QUALITY ASSURANCE: If your project involves environmentally
related measurements or data generation, the recipient shall
develop and implement quality assurance practices sufficient to
produce data of quality adequate to meet project objectives and to
minimize loss of data due to out-of-control conditions or
malfunctions. Applicants who are State, Local, or Indian Tribal
governments, see EPA regulation 40 CFR 31.45. Other applicants,
•see EPA regulation 40 CFR 30.503. '•
BUDGET: The application includes a two-page sheet, "Budget
Information - Non-Construction Programs" (Standard Form 424A).
(You do not need to read the "Instructions for the SF-424A".)
Please complete "Section B - Budget Categories". Use one
column for each budget period and insert the total for the project
period in Column 5. Attach an extra sheet if your project will
have more than four budget periods. The dates for each budget
period should be entered at the top of each column, on the "Object
Class Categories" line.
Most EPA programs require that you cost share at least 5% of
total costs. The amounts you insert in Section B should include
EPA's share plus your cost sharing and the cost sharing from all
other sources except other federal agencies. Under "Totals" on
Line K, please squeeze in the EPA amount requested for each budget
period and for the project period. On Line 7, "Program Income,
enter the estimated amount of income, if any, expected to be
generated from this project. Do not add or subtract this amount
from the total project amount. Your detailed itemijiation of direct
costs, which is described below, should show the nature and source
of this income.
-------
You need not complete Sections A, C, D, or E of the budget
page. In Section F, under "Remarks" please enter the type of
indirect cost rate (provisional, predetermined, final or fixed)
that will be in effect during the budget period, the rate, the base
to which the rate is applied, and the Federal agency with whom your
rate is negotiated. (Not applicable when indirect costs are not
budgeted in Section B.)
For the budget period currently under consideration please
submit a separate sheet(s) itemizing the direct costs of Lines (a)
thru (j) of Section B. Guidelines for the itemization are provided
below.
DETAILED ITEMIZATION OP COSTS:
* Line A - Personnel: List all participants in the project
by position title. Give the percentage of the budget period for
which they will be fully employed on the project (e.g., half-time
for half the budget period equals 25 percent, full-time for half
the budget period equals 50 percent, etc.). Give the annual salary
and the total cost over the budget period for all personnel listed.
* Line C - Travel: If travel is budgeted, show destination
and purpose of travel as well as costs.
* Line D - Equipment: Identify all equipment to be
purchased.
* Line E - Supplies: If the supply budget is less than 2% of
total costs, you do not need to itemize.
* Line F - Contractual: Specify the nature and cost of such
services. EPA may require review of contracts for personal
services prior to their execution to assure that all costs are
reasonable and necessary to the project.
* Line G - Construction: Contact the Grants Administration
Division for additional instructions prior to completing your
application if your budget includes construction costs.
* Line H - Other: Specify all costs included under this
category. If you are applying for a training project, your
itemization of "Other" should include a breakdown of posts for
trainee tuition and fees, book allowance, stipends and travel.
* Line J - Indirect Costs: Provide an explanation of how
indirect charges were calculated for this project. Please attach
a copy of your current negotiated Indirect Cost Rate Agreement. If
you do not have a current negotiated rate, a rate must be
negotiated within 90 days from receipt of an EPA assistance
agreement.
-------
ADDITIONAL TIPS FOR COMPLETING THE 87-424
(1) If your application is being submitted under the Federal
Demonstration Project, please indicate it in Block 11 on Page i.
(2) If your project requires an Environmental Impact
Statement and/or and Environmental Assessment, please indicate it
on a separate sheet of paper.
(3) If your project involves human testing studies, please
indicate it on a separate sheet of paper.
(4) If your project involves animal testing studies, please
indicate it on a separate sheet of paper.
(5) Please fill out the reverse side of the '"Assurances -
Non-Construction Programs" (Standard Form 424B) and have the
authorized certifying official sign that page as well as the 1st
page.
(6) If you wish to receive notification that we have received
your application, please fill in your address on the enclosed
application receipt letter. EPA will fill in the pertinent
information regarding your project and mail the letter back to the
addressee.
r***
-------
-------
CHECKLIST OF APPLICATION
ITEMS TO BE SUBMITTED
SF-424 APPLICATION FOR FEDERAL ASSISTANCE WITH ORIGINAL SIGNATURE
(Including Assurances for Non-Construction Programs)
RESEARCH PROJECTS: Original and 8 copies
ALL OTHER TYPE PROJECTS: Original and 2 copies
6700-48 PROCUREMENT SYSTEM CERTIFICATION
5700-49 DEBARMENT AND SUSPENSION CERTIFICATION
LOBBYING CERTIFICATION AND DISCLOSURE
(If applying for more than $100,000)
NARRATIVE STATEMENT (Including statement on hov* this
project supports your environmental program)
QUALITY ASSURANCE NARRATIVE STATEMENT, If applicable
ITEMIZED BUDGET (Detailed)
BIOGRAPHICAL SKETCH OF THE PROJECT MANAGER
COPY OF NEGOTIATED INDIRECT COST RATE AGREEMENT
(If applicant does not have a negotiated Indirect cost
rate agreement Indicate under Itemized budget)
COPY OF STATE CLEARINGHOUSE APPROVAL NOTIFICATION
(Applicable »f "Yes" under block number 16, page 1
of appllcatloa)
KEY CONTACT LIST
APPLICATION RECEIPT LETTER
(Optional)
-------
-------
APPLICATION RECEIPT LETTER
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 2046Q
OFFICE OF
ADMINISTRATION
ANDRESOUCES
MANAGEMENT
Dear Applicant:
Your application has been received by the U.S. Environmental
Protection Agency's Grants Operations Branch. The EPA
identification number assigned to your project is
The Grants Specialist for this project is — ; "
If you have any questions, please contact your Grants
Specialist on (202) .
Sincerely yours,
Cheryl Clark
Assistance Management Section C
Grants Operations Branch
-------
-------
KEY CONTACTS
Authorized Representative: Original awards and amendments will be
sent to this individual for review and acceptances, unless otherwise
•I w» *3 -i y^ —» 4— *-v /"3
indicated.
Name:
Title:
Complete Address:.
Phone Numbei.;
Payee: Individual authorized to accept payments.
Name:
Title:
Complete Address:.
Phone Number:
Administrative Contact: Individual from Sponsored Programs Office
to contact concerning administrative matters (i.e., indirect cost
rate computation, rebudgeting requests etc*)
Name:
Title:
Complete Address:.
Phone Number:
Project Manager: Individual responsible for the technical
completion of the proposed work.
Name:_
Title;
Complete Address:.
Phone Number:
-------
-------
OMB Approval No. 034«-0043
AHHLIUMMUN r-UH 2. DATE suB-rmo Applicant ^ntifie,
FEDERAL ASSISTANCE *"
1. TYPE OF SUBMISSION:
Application Preapplic
Q Construction Q Const
[3 Non-Construction n Non-C
3. DATE RECEIVED BY STATE State Application Identifier
ation
4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
onstruction
5. APPLICANT INFORMATION
Legal Name.
Address (give city, county, slate, and zip code):
«. EMPLOYER IDENTIFICATION NUMBER (EIM|:
—
». TYPE OF APPLICATION:
n New
If Revision, enter appropriate letter(s) in t
A Increase Award 3. Decrease t
0 Decrease Duration Other (specif'
11. CATALOG Of FEDERAL DOMESTIC
ASSISTANCE NUMBER:
TITLE:
12. AREAS AFFECTED BY PROJECT (Citios.
I! PROPOSED PROJECT:
Start Date Ending Date
IS. ESTIMATED FUNDING:
a Federal $
b. Applicant S
c State f
d. Local $
e Other $
f Program Income 9
g TOTAL 9
Q Continuation Q Revision
xw(es): 1 1 1 1
kward C Increase Duration
rt
m
counties, state*. efc.J:
Organizational Unit:
Name and telephone number of Iho parson to be contacted on matters involving
this application (give area code)
7. TYPE Of APPLICANT: (enter appropriate lettar in b
A. Stale H Independent Schoc
B. County 1. Staid Controlled Ins
C. Municipal J. Private University
D. Township K. Indian Tribe
E. Interstate L. Indrrtdual
F. tntermuniopal M. Profit Orgcrwabon
Q. Special District N Other (Specify).
ox) Q
JDist.
ititution of Higher Learning
S. NAME Of FEDERAL AGENCY:
11. DESCRIPTIVE TITLE Of APPLICANTS PROJECT:
1
14. CONGRESSIONAL DISTRICTS OF:
a. Applicant b Protect
If. IS APPLICATION SUBJECT TO REVIEW BV STATE DXCUTIVE ORDER 11171 PROCESS?
00 a. YES. THIS PREAPPUCATK3N/APPUCATICIN WAS MADE AVALABLE TO THE
STATE EXECUTIVE ORDER 12372 PROCESS FOR REVEW ON;
•°° DATE
b NO Q PROGRAM IS NOT COVERED IBVE.O. 12372
.00
.00
.00 17. ISTHEAPPLK
[^ »es l
| OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
>MT DELINQUENT ON ANY FEDERAL OEBfT
f "Yes," attach an explanation.
D No
11. TO THE BEST OF MY KNOWLEDGE AND BEUEP. ALL DATA IN THIS APPUCATOM/PREAPPLICATtON ARE TRUE AND COHRECV. THE DOCUMENT HAS BEEN DULY
a. Typed Name of Authorized Representative
b Title
d Signature of Authorized Representative
c. Telephone number
e. Data Signed
Previous Editions Not Usable
Standard Form 424 (REV 4-88)
Prescribed by OMB Circular A-102
Authorized for Local Reproduction
-------
INSTRUCTIONS FOR THE SF 424
This is a standard form used by applicants as a required facesheet for preapplications and applications submitted
for Federal assistance. It will be used by Federal agencies to obtain applicant certification that States which have
established a review and comment procedure in response to Executive Order 12372 and have selected the program
to be included in their process, have been given an opportunity to review the applicant's submission.
Entrv:
Item: Entry:
1. Self-explanatory.
2. Date application submitted to Federal agency (or
State if applicable) & applicant's control number
(if applicable).
3. State use only (if applicable).
If this application is to continue or revise an
existing award, enter present Federal identifier
number. If for a new project, leave blank.
Legal name of applicant, name of primary
organizational unit which will undertake the
assistance activity, complete address of the
applicant, and name and telephone number of the
person to contact on matters related to this
application.
Item:
12.
4.
5.
6.
8.
Enter Employer Identification Number (EIN) as
assigned by the Internal Revenue Service.
7. Enter the appropriate letter in the space
provided.
Check appropriate box and enter appropriate
letter(s) in the space(s) provided:
—"New" means a new assistance award.
— "Continuation" means an extension for an
additional funding/budget period for a project
with a projected completion date.
—"Revision" means any change in the Federal
Government's financial obligation or
contingent liability from an existing
obligation.
Name of Federal agency from which assistance is
being requested with this application.
Use the Catalog of Federal Domestic Assistance
number and title of the program under which
assistance is requested.
Enter a brief descriptive title of the project, if
more than one program is involved, you should
append an explanation on a separate sheet. If
appropriate (e.g., construction or real property
projects), attach a map showing project location.
For preapplications, use a separate sheet to'
provide a summary description of this project.
9.
10.
11.
List only the largest political entities affected
(e.g., State, counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and
any District(s) affected by the program or project.
15. Amount requested or to be contributed during
the first funding/budget period by each
contributor. Value of in-kind contributions
should be included on appropriate lines as
applicable. If the action will result in a dollar
change to an existing award, indicate only the
amount of the change. For decreases, enclose the
amounts in parentheses. If both basic and
supplemental amounts are included, show
breakdown on an attached sheet. For multiple
program funding, use totals and show breakdown
using same categories as item 15.
16. Applicants should contact the State Single Point
of Contact (SPOC) for Federal Executive Order
12372 to determine whether the application is
subject to the State intergovernmental review
process.
17. This question applies to the applicant organi-
zation, not the person who signs as the
authorized representative. Categories of debt
include delinquent audit disallowances, loans
and taxes.
18. To be signed by the authorized representative of
the applicant. A copy of the governing body's
authorization for you to sign this application as
official representative must be on file in the
applicant's office. (Certain Federal agencies may
require that this authorization be submitted as
part of the application.)
SF 424 (REV <-«8) Back
-------
JC
o
a
o
V
c
o
z
I
o
F=
S
oc
O
a
3
QB
1
i
i
3
-------
L RESOURCES
-FEDERAI
z
O
z
u
z
o
6
Ul
VI
_j
»~
0
_
S.
u
5
£
I
^
s
2
n
—
j
£
|
1
|
O
"i
^
„
V*
•a
o>
0
£
«»
„
Wt
*»
~
•o
c
CO
5
c
"o
E
3
Ut
<
O
IN
0
Ul
Ul
Z
I
VI
ECASTED
oe
O
u.
1
O
O
5
Ul
(/i
r
•
J
£
*
«
C
•o
C
<§
•o
c
i
Ul Y««r
8
•
£
v,
v.
^
*"
Federal
2
NonFeden
W
^
M
wt
M
*"
5"
•o
c
*
rn
M«
41
C
"o
E
1
ui
C
UJ
o
te.
a.
UJ
h-
u*
o
Ul
<
^
NEEDED FOR B
.
a
i
a
§
2
|
c
3
O
-J
*"*
•o
1
1
W
5
Ji
|
§
I
f
I
0
•T
^
M
„
V,
-------
INSTRUCTIONS FOR THE SF-424A
General Instructions
This form is designed so that application can be made
for funds from one or more grant programs. In pre-
paring the budget, adhere to any existing Federal
grantor agency guidelines which prescribe how and
whether budgeted amounts should be separately
shown for different functions or activities within the
program. For some programs, grantor agencies may
require budgets to be separately shown by function or
activity. For other programs, grantor agencies may
require a breakdown by function or activity. Sections
A,B,C, and D should include budget estimates for the
whole project except when applying for assistance
which requires Federal authorization in annual or
other funding period increments. In the latter case,
Sections A,B, C, a"d D should provide the budget for
the first budget period (usually a year) and Section E
should present the need for Federal assistance in the
subsequent budget periods. All applications should
contain a breakdown by the object class categories
shown in Lines a-k of Section B.
Section A. Budget Summary
Lines 1-4, Columns (a) and (b)
For applications pertaining to a single Federal grant
program (Federal Domestic Assistance Catalog
number) and not requiring a functional or activity
breakdown, enter on Line 1 under Column (a) the
catalog program title and the catalog number in
Column (b).
For applications pertaining to a single program
requiring budget amounts by multiple functions or
activities, enter the name of each activity or function
on each line in Column (a), and enter the catalog num-
ber in Column (b). For applications pertaining to mul-
tiple programs where none of the programs require a
breakdown by function or activity, enter the catalog
program title on each line in Column (a) and the
respective catalog number on each line in Column (b).
For applications pertaining to multiple programs
where one or more programs require a breakdown by
function or activity, prepare a separate sheet for each
program requiring the breakdown. Additional sheets
should be used when one form does not provide
adequate space for all breakdown of data required.
However, when more than one sheet is used, the first
page should provide the summary totals by programs.
Lines 1-4, Columns (c) through (g.)
For new applications, leave Columns (c) and (d) blank.
For each line entry in Columns (a) and (b), enter in
Columns (e), (0, and (g) the appropriate amounts of
funds needed to support the project for the first
funding period (usually a year).
Lines 1-4, Columns (<:) through (g.) (continued)
For continuing grant program applications, submit
these forms before the end of each funding period as
required by the grantor agency. Enter in Columns (c)
and (d) the estimated amounts of funds which will
remain unobligated at the end of the grant funding
period only if the Federal grantor agency instructions
provide for this. Otherwise, leave these columns
blank. Enter in columns (e) and (f) the amounts of
funds needed for the upcoming period. The amount(s)
in Column (g) should be the sum of amounts in
Columns (e) and (f).
For supplemental grants and changes to existing
grants, do not use Columns (c) and (d). Enter in
Column (e) the amount of the increase or decrease of
Federal funds and enter in Column (0 the amount of
the increase or decrease of non-Federal funds. In
Column (g) enter the new total budgeted amount
(Federal and non-Federal) which includes the total
previous authorized budgeted amounts plus or minus,
as appropriate, the amounts shown in Columns (e) and
(f). The amount(s) in Column (g) should not equal the
sum of amounts in Columns (e) and (f).
Line 5 — Show the totals for all columns used.
Section B Budget Categories
In the column heading (1) through (4), enter the titles
of the same programs, functions, and activities shown
on Lines 1-4, Column (a), Section A. When additional
sheets are prepared for Section A, provide similar
column headings on each sheet. For each program,
function or activity, fill in the total requirements for
funds (both Federal and non-Federal) by object class
categories.
Lines 6a-i •
column.
• Show the totals of Lines 6a to 6h in each
Line 6j - Show the amount of indirect cost.
Line 6k - Enter the total! of amounts on Lines 6i and
6j. For all applications for new grants and
continuation grants the total amount in column (5),
Line 6k, should be the same as the total amount shown
in Section A, Column (g), Line 5. For supplemental
grants and changes to gr;ints, the total amount of the
increase or decrease as shown in Columns (l)-(4). Line
6k should be the same a» the sum of the amounts in
Section A, Columns (e) and (f) on Line 5.
SF 424A (4-88) paga3
-------
INSTRUCTIONS FOR THE SF-424A (continued)
Line 7- Enter the estimated amount of income, if any,
expected to be generated from this project. Do not add
or subtract this amount from the total project amount.
Show under the program narrative statement the
nature and source of income. The estimated amount of
program income may be considered by the federal
grantor agency in determining the total amount of the
grant.
Section C. Non-Federal-Resources
Lines 8-11 - Enter amounts of non-Federal resources
that will be used on the grant. If in-kind contributions
are included, provide a brief explanation on a separate
sheet.
Column (a) - Enter the program titles identical
to Column (a), Section A. A breakdown by
function or activity is not necessary.
Column (b) - Enter the contribution to be made
by the applicant.
Column (c) - Enter the amount of the State's
cash and in-kind contribution if the applicant is
not a State or State agency. Applicants which are
a State or State agencies should leave this
column blank.
Column (d) - Enter the amount of cash and in-
kind contributions to be made from all other
sources.
Column (e) - Enter totals of Columns (b), (c), and
(d).
Line 12 — Enter the total for each of Columns (b)-(e).
The amount in Column (e) should be equal to the
amount on Line 5, Column (f). Section A.
Section D. Forecasted Cash Needs
Line IS - Enter the amount of cash needed by quarter
from the grantor agency during the first year.
Line 14 - Enter the amount of cash from all other
sources needed by quarter during the first year.
Line 15 - Enter the totals of amounts on Lines 13 and
14.
Section E. Budget Estimates of Federal Funds
Needed for Balance of the Project
Lines 16-19 - Enter in Column (a) the same grant
program titles shown in Column (a), Section A. A
breakdown by function or activity is not necessary. For
new applications and continuation grant applications,
enter in the proper columns amounts of Federal funds
which will be needed to complete the program or
project over the succeeding funding periods (usually in
years). This section need not be completed for revisions
(amendments, changes, or supplements) to funds for
the current year of existing grants.
If more than four lines are needed to list the program
titles, submit additional schedules as necessary.
Line 20 - Enter the total for each of the Columns (b)-
(e). When additional schedules are prepared for this
Section, annotate accordingly and show the overall
totals on this line.
Section F. Other Budget Information
Line 21 - Use this space to explain amounts for
individual direct object-class cost categories that may
appear to be out of the ordinary or to explain the
details as required by the Federal grantor agency.
Line 22 - Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect
during the funding period, the estimated amount of
the base to which the rate is applied, and the total
indirect expense.
Line 23 - Provide any other explanations or comments
deemed necessary.
SF 424A (4-88) page 4
-------
Note:
QMS Approval No.034«-0040
ASSURANCES — NON-CONSTRUCTJON PROGRAMS
Certain of these assurances may not be applicable to your project or program. If you have questions,
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants
to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal
assistance, and the institutional, managerial and
financial capability (including funds sufficient to
pay the non-Federal share of project costs) to
ensure proper planning, management and com-
pletion of the project described in this application.
2. Will give the awarding agency, the Comptroller
General of the United States, and if appropriate,
the State, through any authorized representative,
access to and the right to examine all records,
books, papers, or documents related to the award;
and will establish a proper accounting system in
accordance with generally accepted accounting
standards or agency directives.
3. Will establish safeguards to prohibit employees
from using their positions for a purpose that
constitutes or presents the appearance of personal
or organizational conflict of interest, or personal
gain.
4. Will initiate and complete the work within the
applicable time frame after receipt of approval of
the awarding agency.
5. Will comply with the Intergovernmental
Personnel Act of 1970 (42 U.S.C. §§ 4728-4763)
relating to prescribed standards for merit systems
for programs funded under one of the nineteen
statutes or regulations specified in Appendix A of
OPM's Standards for a Merit System of Personnel
Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not
limited to: (a) Title VI of the Civil Rights Act of
1964 (P.L. 88-352) which prohibits discrimination
on the basis of race, color or national origin; (b)
Title IX of the Education Amendments of 1972, as
amended (20 U.S.C. §§ 1681-1683, and 1685-1686),
which prohibits discrimination on the basis of sex;
(c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. § 794), which prohibits dis-
crimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42
U.S.C.§§ 6101-6107), which prohibits discrim-
ination on the basis of age;
(e) the Drug Abuse Office and Treatment Act of
1972 (P.L. 92-258). as amended, relating to
nondiscrimination on the basis of drug abuse; (0
the Comprehensive Alcohol Abuse and Alcoholism
Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) J § 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-
3), as amended, relating to confidentiality of
alcohol and drug abuse patient records; (h) Title
VIII of the Civil Rights Act of 1968 (42 U.S.C. §
3601 et seq.), as amended, relating to non-
discrimination iin the sale, rental or financing of
housing; (i) any other nondiscrimination
provisions in the specific statute(s) under which
application for Federal assistance is being made;
and (j) the requirements of any other
nondiscrimination <;tatute(s) which may apply to
the application.
7. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property
Acquisition Policies Act of 1970 (P.L. 91-646)
which provide for fair and equitable treatment of
persons displaced or whose property is acquired as
a result of Federal or federally assisted programs.
These requirements apply to all interests in real
property acquired for project purposes regardless
of Federal participation in purchases.
8. Will comply with the provisions of the Hatch Act
(5 U.S.C. l§ 1501-1508 and 7324-7328) which limit
the political activities of employees whose
principal employment activities are funded in
whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of
the Davis-Bacon Act (40 U.S.C. §5 276a to 276a-
7), the Copeland Act (40 U.S.C. § 276c and 18
U.S.C. §§ 874), and the Contract Work Hours and
Safety Standards Act (40 U.S.C. §§ 327-333),
regarding labor standards for federally assisted
construction subagreements.
Standard Form 424B (4-88)
Presented by OMB Ocular A-102
Authorized for Local Reproduction
-------
10. Will comply, if applicable, with flood insurance
purchase requirements of Section 102(a) of the
Flood Disaster Protection Act of 1973 (P.L. 93-234)
which requires recipients in a special flood hazard
area to participate in the program andto purchase
flood insurance if the total cost of insurable
construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which
may be prescribed pursuant to the following: (a)
institution of environmental quality control
measures under the National Environmental
Policy Act of 1969 (P.L. 91-190) and Executive
Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of
wetlands pursuant to EO 11990; (d) evaluation of
flood hazards in floodplains in accordance with EO
11988; (e) assurance of project consistency with
the approved State management program
developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§ 1451 et seq.); (f)
conformity of Federal actions to State (Clear Air)
Implementation Plans under Section 176(c) of the
Clear Air Act of 1955, as amended (42 U.S.C. §
7401 et seq.); (g) protection of underground sources
of drinking water under the Safe Drinking Water
Act of 1974, as amended, (P.L. 93-523); and (h)
protection of endangered species under the
Endangered Species Act of 1973, as amended, (P.L.
93-205).
12. Will comply with the Wild and Scenic Rivers Act
of 1968 (16 U.S.C. §§ 1271 et seq.) related to
protecting components or potential components, of
the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring
compliance with Section 106 of the National
Historic Preservation Act of 1966, as amended (16
U.S.C. 470), EO 11593 (identification and
protection of historic properties), and the
Archaeological and Historic Preservation Act of
1974 (16 U.S.C. 469a-l et seq.).
14. Will comply with P.L. 93-348 regarding the
protection of human subjects involved in research,
development, and related activities supported by
this award of assistance.
15. Will comply with the Laboratory Animal Welfare
Act of 1966 (P.L. 89-544, as amended, 7 U.S.C.
2131 et seq.) pertaining to the care, handling, and
treatment of warm blooded animals held for
research, teaching, or other activities supported by
this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§ 4801 et seq.) which
prohibits the use of lead based paint in
construction or rehabilitation of residence
structures.
17. Will cause to be performed the required financial
and compliance audits in accordance with the
Single Audit Act of 1984.
18. Will comply with all applicable requirements of all
other Federal laws, executive orders, regulations
and policies governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
APPUCANT ORGANIZATION
DATE SUBMITTED
SF 4248 (4-MI B*ck
-------
PROCUREMENT SYSTEM CERTIFICATION
Paperwork Reduction Act Notice
Public reporting burden for the collection
of this information is estimated to average
8 hours per response, including the time for
reviewing instructions, searching existing
data sources, gathering and maintaining the
data needed, and completing and reviewing
this collection of information. Send comments
regarding this burden estimate or any other
aspect of this collection if information,
including suggestions for reducing the burden,
to Chief, Information Policy Branch, PM-223,
U.S. Environmental Protection Agency, 401 M St.
S.W., Washington, D.C. 20460; and to the
Paperwork Reduction Project, Office of
Information and Regulatory Affairs,, Office of
Management and Budget, Washington, D.C. 200503.
EPA Form 5700-48 (Rev. 9-90)
-------
-------
?,EPA
EPA Project Confrd Number
Uradod States
\MuMneean. OC2D400
Certification Regarding
Debarment, Suspension, and Other Responsibility Matters
The prospective participant certifies to the best of fts knowledge and belief that K «nd fts principals:
(a) Are not presently debarred, suspended, proposed for determent, declared ineligible, or voiuntarly
excluded from covered transactions by any Federal department or agency
(b) Have not within a three year period preceding this proposal boon convicted of or had a dvi 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 cMBy charged by a government entity (Federal.
State, or local) wtth commission of any of the offenses enumerated in paragraph (i)(b) of this
certification; and
(d) Have not within a three-year period preceding this appflcation/prcposa! had one or more pubfic
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 13 USC Sec. 1001, a raise statennani: may resuft in a fine of up
to $10,000 or imprisonment for up to 5 years, or both.
Typwd Men* 4 THfc <* Authorized
LJ I am unable to eertfy to tfte above staterrwnts. My explanation to attached.
EPA Fan* CTtMMC (11
-------
instructions
Under Executive Order 12549. an individual or organization debarred or excluded from
participation In Federal assistance or benefit programs may not receive any assistance award
under a Federal program, or a subagreement thereunder for $25,000 or more.
Accordingly, each prospective recipient of an EPA grant, loan, or cooperative agreement and any
contract or subagreement participant thereunder must complete the attached cert!ficatk>n or
provide an explanation why they cannot. For further details, see 40 CFR 32.510. Participants'
responsibilities. In the attached regulation.
Whtr• To Submit
The prospective EPA grant, loan, or cooperative agreement recipient must return the signed
certification or explanation with its application to the appropriate EPA Headquarters or Regional
office, as required In the application Instructions.
A prospective prime contractor must submit a completed certification or explanation to the
Individual or organization awarding the contract.
Each prospective subcontractor must submit a completed certification or explanation to the prime
contractor for the project.
How To Obtain Forms:
EPA includes the certification form. Instructions, and a copy of its implementing reguiajlon (40 CFR
Part 32) hi each application kit Applicants may reproduce thesa materials as needed and provide
them to their prospective prime contractor, who, in turn, may reproduce and provide them to
prospectiv* subcontractors.
Additional copies/assistance may be requested from:
Compliance Branch
Grants Administration DMsion (PM-216F)
U.S. Environmental Protection Agency
401 M SttMt. SW
Washington. DC 20460
(Tatepttan*: 202/475-1025)
• (i tut)
-------
EPA PROJECT CONTROL NUMBER
CERTIFICATION REGARDING
CERTIFICATION FOR CONTRACTS.
LOAMS. AND COOPERATIVE
The undersigned certifies, to the beat of his or her knowleda*
and belief, that: *
(l) No Federal appropriated funds have been or will be paid
by or on behalf of the undersigned, to any person for influencing
or attempting to influence an officer or employee of any agency
a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, th«
making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loim, or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loun, or cooperative
agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with its
instructions.
(3) The undersigned shall require that the language of this
certification be included in the award of docxuaents for all
subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that
all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon
which reliance was placed wh«a this transaction was made or entered
into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by Section 1352,
Title 31, U.S. Code. Any person who fails to ifile the required
certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
TYPED NAME i TITLE OF AUTHORIZED REPRESENTATIVE
SIGNATURE OF AUTHORIZED REPRESENTATIVE DATE
-------
-------
DISCLOSURE OF LOBBYING ACTIVrTIES
Complete thij form to diidote lobbying *ctJviti«i punuant to 31 U.S.C. 1352
(S«« r«v«fi« tor public burd«n diidoture.)
0.1 «*«>«*
1. Type of Federal Action:
r~]O a. contract
O b. grant
O c. cooperative agreement
a d. loan
D e. loan guarantee
D f. loan insurance
2. Status of Federal Action:
d a. bid/offer/application
O b. initial award
O c. post-award
4. Name and Address of Reporting Entity:
a Prime O Subawardee
Tier , if known:
Congressional District, if known:
6. Federal Department/Agency
8. Federal Action Number, if known:
3. Report Type:
a. Initial filing
b. material change
For Material Change Only:
year quarter
date of last report
5. If Reporting Entity in No. 4 is Subawardee, Enter Name
and Address of Prime:
Congressional District, if known:
7. Federal Program Name/Description
CFDA Number, if applicable:
9. Award Amount, if known:
10. a. Name and Address of Lobbying Entity
(if individual, last name, first name, Ml):
b. Individuals Performing Services (including address if
different from No. 10a
(last name, first Name, Ml):
(attach Continuation Sheet(s) SF-LLL-A. if necessary)
1. Amount of Payment (check all that apply):
5 O actual O planned
12. Form of Payment (check all that apply):
r a. cash
r b. in-kind: specify: nature
value
13. Type of Payment (check all that apply):
O a. retainer
D b. one-time fee .
O c. commission
D d. contingent fee ,
O e. deferred
O f. other; specify: _.
(attach Continuation Sheet(s) SF-LLL-A. if necessary)
5. Continuation Sheet(s) SF-LLL-A attached: O Yes: O No
6. Information requested through this form is authorized by title 31
U.S.C. section 1352. This disclosure of lobbying activities is a mate-
rial representation of fact upon which reliance was placed by the
tier above when this transaction was made or entered into. This
disclosure is required pursuant to 31 U.S.C. 1352. This information
will be reported to the Congress semiannually and will be available
for public inspection. Any person who fails to file the required disclo-
sure shall be subject to a civil penalty of not less than $10 000 and
not more than $100,000 for each such failure.
Signature:_
Print Name:
Title:
Telephone No.:
Date:
-------
-------
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient at the
'n't'^tlof!? or,.f.eceiPt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U S C section
1352. I he filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Conqress
or an employee of a Member of Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet
for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and
material change report. Refer to the implementing guidance published by the Office of Management and Budaet for addi-
tional information. a
1.
Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the
outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the
information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last
previously submitted report by this reporting entity for this covered Federal action.
Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known
Check the appropriate classification of the reporting entity that designates if it is, or expects to be a prime or
subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier Subawards
include but are not limited to subcontracts, subgrants and contract awards under grants.
If the organization filing the report in item 4 checks "Subawardee," then enter Ihe full name, address city state and
zip code of the prime Federal recipient. Include Congressional District, if known.
Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan com-
mitments.
Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e q
Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement number the contract'
grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include
prSTIXSS, 6.CJ., i~ir~r^-L)c-90-001."
For a covered Federal action where there has been an award or loan commitment by the Federal agency enter the
l-ederal amount of the award/loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity
identified in item 4 to influence the covered Federal action. ,
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a)
Enter Last Name, First Name, and Middle Initial (Ml). , i i "um iu i«»;.
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the
lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned) Check all
boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution,
specify the nature and value of the in-kind payment. :
13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to
perform, and the datejs) of any services rendered. Include all preparatory and related activity, not just time spent in
actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officers)"
employee(s), or Member(s) of Congress that were contacted.
15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached. !
16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
4.
5.
6.
7.
8.
9.
Public reporting burden for this collection of information is estimated to average 30 minutes per response includinq time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and compteSS
and reviewing the co action of information. Send comments regarding the burden estimate or any other aspect of hil
collection of information, including suggestions for reducing this burden, to the Office of Management and Budqet
Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. m
-------
Return Completed Applications
to the
Office of Exploratory Research
at the Following Address:
U.S. Environmental Protection Agency
Office of Research and Development
Office of Exploratory Research (8703)
Room3102NEM
401 M Street, SW
Washington DC 20460
Phone 202/260-7473
------- |