EPA
United States
Environmental Protection
Agency
Small Grant Program
Application Guidance
FY2003
COVER PHOTO COURTESY OF Detroit Summer '94 4605 < 'ass Avenue, Detroit Michigan 48201
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United States Enforcement and October 2002
Environmental Protection Compliance Assurance
Agency (2201 A) http://www.epa.gov/compliance/environmentaliustice
Office of Environmental Justice
FOR ADDITIONAL COPIES CONTACT YOUR REGIONAL
EJ COORDINATOR FOUND ON PAGES 9 - 11.
Inside Front Cover
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 1
INTRODUCTION
This guidance outlines the purpose, goals, and general procedures for application and award
under the Fiscal Year (FY) 2003 Environmental Justice Small Grants Program. During FY
2003 (October 1, 2002 - September 30, 2003), the EPA will make available approximately
$1,500,000 in grant funds to eligible organizations (pending availability of funds). The application
must be delivered by close of business Wednesday, December 18, 2002 to your appropriate
EPA regional office (listed in Section III) or postmarked by the U. S. Postal Service midnight
Wednesday, December 18, 2002.
Catalogue of Federal Domestic Assistance Number: 66.604 Environmental Justice Small
Grants Program.
This guidance includes the following:
I. Scope and Purpose of the Environmental Justice Small Grants Program
II. Eligible Applicants and Activities
III. Application Requirements
IV. Process for Awarding Grants
V. Expected Time-frame for Reviewing and Awarding Grants
VI. Project Period and Final Reports
VII. Fiscal Year 2004 Environmental Justice Small Grants Program
Appendix A: Tips on Preparing an Application
Appendix B: Standard Forms 424 and 424A and Completed Sample Forms
Appendix C: Copy of 40 CFR 30.27 "Allowable Costs"
Appendix D Guidance on Lobbying Restrictions
Appendix E: State Single Points of Contact
Appendix F: Additional Government Application Forms
Translations Available
The Spanish translation of this application is available at
http ://www.epa.gov/compliance/envJronmentaliustice/grants/ Please note the forms are
translated into Spanish but MUST be completed in English.
I. SCOPE AND PURPOSE OF THE OEJ SMALL GRANTS PROGRAM
The purpose of this grant program is to provide financial assistance to eligible community groups
(i.e., community-based/grassroots organizations, churches1, or other nonprofit organizations with
a focus on community-based issues) and federally recognized tribal governments that are working
Churches that qualify as nonprofit organizations may use EPA grant funds only for environmental justice
projects EPA grant funds may not be used to advance religious point of views.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 2
on or plan to carry out projects to address environmental justice issues. Preference for awards
will be given to community-based/grassroots organizations that are working on local
solutions to local environmental problems. Funds can be used to develop a new activity or
substantially improve the quality of existing programs that have a direct impact on affected
communities. All awards will be made in the form of a grant not to exceed one year.
Background
In its 1992 report, "Environmental Equity: Reducing Risk for All Communities" the EPA found
that minority and/or low-income populations may experience higher than average exposure to
toxic pollutants than the general population. The EPA established the Office of Environmental
Justice (OEJ) in 1992 to help these communities identify and assess pollution sources, to
implement environmental awareness and training programs for affected residents, and to work
with community stakeholders to devise strategies for environmental improvements.
In June of 1993, OEJ was delegated granting authority to solicit, select, supervise, and evaluate
environmental justice-related projects, and to disseminate information on the projects' content and
effectiveness. FY 1994 marked the first year of the OEJ Small Grants Program The chart below
shows how the grant monies have been distributed since FY 1994.
Fiscal Year $ Amount Number of Awards
1994 500,000 71
1995 3,000,000 175
1996 2,800,000 152
1997 2,700,000 139
1998 2,500,000 123
1999 1,455,000 95
2000 899,000 61
2001 1,300,000 88
2002 1,113,000 73
How does EPA Define Environmental Justice Under the Environmental Justice Small Grants
Program?
Environmental justice is the fair treatment and meaningful involvement of all people regardless
of race, color, national origin, culture, education, or income with respect to the development,
implementation, and enforcement of environmental laws, regulations, and policies. Fair treatment
means that no one group of people, including racial, ethnic, or socioeconomic groups, should bear
a disproportionate share of the negative environmental consequences resulting from industrial,
municipal, and commercial operations or the execution of federal, state, local, and tribal
environmental programs and policies. Meaningful involvement means that: (1) potentially
affected community residents have an appropriate opportunity to participate in decisions about a
proposed activity that will affect their environment and/or health; (2) the public's contribution can
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 3
influence the regulatory agency's decision; (3) the concerns of all participants involved will be
considered in the decision-making process; and (4) the decision-makers seek out and facilitate the
involvement of those potentially affected.
II. ELIGIBLE APPLICANTS AND ACTIVITIES
A. Who May Submit Applications and May Applicants Submit More Than One?
Any affected, non-profit community organization2 or federally recognized tribal government may
submit an application upon publication of this solicitation. Applicants must be non-profit to
receive these federal funds. State-recognized tribes or indigenous peoples' organizations can
apply for grant assistance if they meet the definition of a nonprofit organization. "Non-profit
organization" means any corporation, trust, association, cooperative, or other organization that:
(1) is operated primarily for scientific, educational, service, charitable, or similar purposes in the
public interest; (2) is not organized primarily for profit; and (3) uses its net proceeds to maintain,
improve, and/or expand its operations. Non-profit status may be demonstrated through
designation by the Internal Revenue Service as a 501(c) organization or evidence that a state
recognizes the organization's non-profit status. While state and local governments and academic
institutions are eligible to receive grants, preference will be given to non-profit, community-
based/grassroots organizations and federally recognized tribal governments. Preference may
be given to those organizations that have not received previous grants under the Environmental
Justice Small Grants Program. Individuals are not eligible to receive grants.
The Environmental Justice Small Grants Program is a competitive process. In order to ensure a
fair evaluation process, the Agency will offer training and/or conference calls on grant application
guidelines. We encourage you to participate so that you can have your questions answered in a
public forum. Call your Regional office to inquire about the scheduled dates of the special
training and conference calls. (See Contact List on pages 9-11)
The EPA will consider only one application per applicant for a given project. Applicants may
submit more than one application if the applications are for separate and distinct projects or
activities. Applicants that previously received small grant funds may submit an application for FY
2003 funds (October 1, 2002 - September 30, 2003). Every application for FY 2003 is evaluated
based on the merit of the proposed project in comparison to other FY 2003 applications. Past
performance will be considered during the ranking and evaluation process for those applicants
who have received previous grants.
2 ) As a result of the Lobbying Disclosure Act of 1995, EPA (and other federal agencies) may not award
grants to non-profit organizations that are classified as 26 U.S.C. 501(c)(4) organizations by the Internal Revenue
Service and engage in lobbying activities.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
B. What Types of Projects Are Eligible for Funding?
While there are many applications submitted from community groups for equally worthwhile
projects, the EPA is emphasizing the availability of funds for research projects. Projects which
are research-oriented and specific to hazardous substances are considered for funding under the
Comprehensive Environmental Response, Compensation and Liability Act (CERCLA). The OEJ
Small Grants Program also awards grants on a multi-media basis. Multimedia projects address
pollution in more than one environmental medium (e.g., air, water, etc.).
To be considered for funding, the application must meet the criteria of two statutes under Item 1
or the single statute under Item 2 below:
1. Multi-Media Requirements (use two)
Recipients of these funds must implement projects that address pollution in more than one
environmental medium (e.g., air, water). To show evidence of the breadth of the project's scope,
the application must identify at least two environmental statutes that the project will address. To
be eligible for funding, your project must include activities outlined in the following environmental
statutes:
A. Statutes
1) Clean Water Act, Section 104(b) (3): conduct and promote the coordination of
research, investigations, experiments, training, demonstration, surveys, and studies
relating to the causes, extent, prevention, reduction, and elimination of water
pollution.
2) Safe Drinking Water Act, Section 1442(c)(3)(A): develop, expand, or carry out
a program (that may combine training, education, and employment) for
occupations relating to the public health aspects of providing safe drinking water.
3) Solid Waste Disposal Act, Section 8001 (a): conduct and promote the
coordination of research, investigations, experiments, training, demonstrations,
surveys, public education programs, and studies relating to solid waste (e.g., health
and welfare effects of exposure to materials present in solid waste and methods to
eliminate such effects).
4) Clean Air Act, Section 103(b) (3): conduct research, investigations, experiments,
demonstrations, surveys, and studies related to the causes, effects (including health
and welfare effects), extent, prevention, and control of air pollution.
5) Toxic Substances Control Act, Section 10(a): conduct research, development,
monitoring, public education, training, demonstrations, and studies on toxic
substances
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 5
6) Federal Insecticide, Fungicide, and Rodenticide Act, Section 20(a): conduct
research, development, monitoring, public education, training, demonstrations, and
studies on pesticides.
7) Marine Protection, Research, and Sanctuaries Act, Section 203: conduct
research, investigations, experiments, training, demonstrations, surveys, and
studies relating to the minimizing or ending of ocean dumping of hazardous
materials and the development of alternatives to ocean dumping.
8) Noise Control Act of 1972, Section 14 (b): conduct research on the effects,
measurement, and control of noise.
B. Goals for multi-media projects.
In addition to the requirements outlined above, the application must also include a description of
how an applicant plans to meet at least two of the three program goals listed below. See Section
III "Application Requirements" for more details.
1) Identify necessary improvements in communication and coordination among all
stakeholders, including existing community-based/grassroots organizations and
local, state, tribal, and federal environmental pro grams. Facilitate communication
and information exchange, and create partnerships among stakeholders to address
disproportionate, high and adverse environmental exposure (e.g., workshops,
awareness conferences, establishment of community stakeholder committees);
2) Build community capacity to identify local environmental justice problems and
involve the community in the design and implementation of activities to address
these concerns. Enhance critical thinking, problem-solving, and active
participation of affected communities. (E.g., train-the-trainer programs).
3) Enhance community understanding of environmental and public health information
systems and generate information on pollution in the community. If appropriate,
seek technical experts to demonstrate how to access and interpret public
environmental data (e.g., Geographic Information Systems (GIS), Toxic Release
Inventories (TRI) and other databases).
2. Requirements for Research grants funded under CERCLA:
Recipients of these funds must implement projects that are specifically research oriented and
specific to hazardous substances. The EPA's grant regulations define "research" as "systematic
study directed toward fuller scientific knowledge or understanding of the subject studied," 40
CFR 30.2(dd). The EPA has interpreted "research" to include studies that extend to
socioeconomic, institutional, and public policy issues as well as the "natural" sciences. Your
research project MUST meet the following criteria:
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 6
A. Eligibility
1) CERCLA, Section 31 l(c) authorizes EPA to fund research grants. Research must
relate to the detection, assessment, and evaluation of the effects on and risks to
human health from hazardous substances and the detection of hazardous
substances in the environment.
2) Applicants must demonstrate that the research project relates to "hazardous
substances" as that term is defined by CERCLA 101 (14). There is a list of
hazardous substances at 40 CFR 302.4 which, while not exclusive, does provide
useful guidance.
3) Research funded under CERCLA 31 l(c) cannot relate to contamination from
petroleum products in accordance with the definition of hazardous substances
found at CERCLA 101 (14). Projects that involve petroleum contamination that is
"mixed" with other contaminants may be considered on a case by case basis.
4) The project must be of a research nature only, i.e., survey, research, collecting and
analyzing data which will be used to expand scientific knowledge or understanding
of the subject studied. Research projects, however, need not be limited to
academic studies. Projects which expand the scientific knowledge or
understanding, of a community, about hazardous substances issues, that effect their
community, can be funded.
5) The project cannot carry out training activities, other than training in research
techniques. In other words CERCLA 31 l(c) research projects cannot be designed
as outreach, technical assistance, or public education activities.
6) The project can include conferences only if the purpose of the conference is to
present research results or to gather research data.
B. Goal for Research Projects.
In addition to the special research requirements for grants under CERCLA outlined above, the
application must include a description of how the research projects can serve as models for other
communities when confronted with similar problems. See Section III "Application
Requirements" for more details.
Please note:
1) If your project includes scientific research and/or data collection, you must be prepared to
submit a Quality Assurance Plan (QAP) to your EPA Project Officer prior to the beginning of the
research. Multi-media projects may also require a Quality Assurance Plan.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 7
2) CERCLA grants are limited to research as required under CERCLA 31 l(c). Do not propose
projects which include activities under the "multi-media" authorities described in Section 1.
above, to carry out a research project.
The issues discussed above may be defined differently among applicants from various geographic
regions, including areas outside the continental U.S. (Alaska, American Samoa, Guam, Hawaii,
Puerto Rico, and the U.S. Virgin Islands). Each application should define its issues as they relate
to the specific project. The narrative/work plan must include a succinct explanation of how the
project may serve as a model in other settings and how it addresses a high-priority environmental
justice issue. The degree to which a project addresses a high-priority environmental justice issue
will vary and is defined by applicants according to their local environmental justice concerns.
C. How Much Money May be Requested, and are Matching Funds Required?
The ceilings in federal funds for individual grants are $15,000 for Multi-Media projects and
$20,000 for Research projects. Applicants are not required to provide matching funds.
D. Are There Any Restrictions on the Use of the Federal Funds?
Yes. EPA grant funds can only be used for the purposes set forth in the grant agreement, and be
consistent with the statutory authority for the award. Grant funds from this program cannot be
used for matching funds for other federal grants, lobbying, or intervention in federal regulatory or
adjudicatory proceedings. In addition, the recipient may not use these federal assistance funds to
sue the federal government or any other government entity. Refer to 40 CFR 30.27, entitled
"Allowable Costs" (see Appendix C). The scope of environmental justice grants may not include
construction, promotional items (e.g., T-shirts, buttons, hats), and furniture purchases.
III. APPLICATION REQUIREMENTS
A. What is Required for Applications?
Proposals from eligible organizations must have the following:
1. Application for Federal Assistance (SF 424) the official form is required for all
federal grants that requests basic information about the grantee and the proposed
project. The applicant must submit the original application, and one copy, signed
by a person duly authorized by the governing board of the applicant. Please
complete Part 10 of the SF 424 form, "Catalog of Federal Domestic Assistance
Number" with the following information: 66.604 - Environmental Justice
Small Grants Program. See Appendix B for a copy of this form and a completed
sample.
2. The Federal Standard Form (SF 424A) and budget detail, which provides
information on your budget. For the purposes of this grant program, complete
only the non shaded areas of SF 424A. See Appendix B for a copy and
completed sample of a budget detail. Budget figures/projections should support
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 8
your work plan/narrative. The EPA portion of each grant will not exceed $15,000
for Multi-Media or $20,000 for Research projects. Therefore, your budget should
reflect this limit on federal funds.
3. A narrative/work plan of the proposal is not to exceed five pages. A
narrative/work plan describes the applicant's proposed project. The pages of the
work plan must be letter size (8%xll inches), with normal type size (12
characters per inch), and at least 1" margins.
The narrative/work plan is one of the most important aspects of your application
and (assuming that all other required materials are submitted) will be used as the
primary basis for selection. Work plans must be submitted as follows;
a. A one page summary that includes the following:
• Identifies the environmental justice issue(s) to be addressed by the project;
• Identifies the Environmental Justice community/target audience;
• Identifies the environmental Statutes/Acts addressed by the project; and
• Identifies the program goal that the project will meet and how it will meet
them
b. A concise introduction that states the nature of the organization (i.e., how long it
has been in existence, if it is incorporated, if it is a network, etc.), how the
organization has been successful in the past, purposes of the project, the
environmental justice community/target audience, projects completion plans/time
frames, and expected results.
c. A concise project description that describes how the applicant is community-based
and/or plans to involve the target audience in the project and how the applicant
plans to meet at least two of the three program goals outlined in Section IIB:
"Environmental Justice Small Grants Program Goals." Additional credit will not
be given for projects that fulfill more than two goals.
d. A conclusion discussing how the applicant will evaluate and measure the success
of the project, including the anticipated benefits and challenges in implementing the
project.
4. An appendix with resumes of up to three key personnel who will be significantly
involved in the project.
5. Letter(s) of commitment. If your proposed project includes the significant
involvement of other community organizations, your application must include
letters of commitment from these organizations.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 9
6. Non-Profit Status. The applicant must provide documentation in evidence of
the organization's non-profit status.
Applications that do not include the information listed above in items 1- 4 and item 5, if
applicable, will not be considered for an award.
Please mark any information in the proposal that you consider confidential. EPA will follow the
procedures at 40 CFR Part 2 if information marked confidential is requested from the Agency
under the Freedom of Information Act.
Please note: Your application to this EPA program may be subject to your state's
intergovernmental review process and/or the consultation requirements of Section 204,
Demonstration Cities and Metropolitan Development Act. See 40 CFR Part 29 for details. Check
with your state's Single Point of Contact to determine your requirements. Some states do not
require this review. Applicants from American Samoa, Guam, Puerto Rico, and the U.S. Virgin
Islands should also check with their Single Point of Contact. A list of the states Single Point of
Contact is provided in Appendix E and you may also call your EPA regional contact (listed
below) or EPA Headquarters Grants Policy, Information and Training Branch at (202) 564-5325
for additional information. If your state does not have a single point of contact you must notify
directly affected state, local and area wide agencies if your application is selected for an award.
See 40 CFR 29.7(b). Federally recognized tribal governments are not required to comply
with this procedure.
B. When and Where Must Applications be Submitted?
The applicant must submit/mail one signed original application with required attachments and one
copy to the primary contact at the EPA regional office listed below. The application must be
delivered by close of business Wednesday, December 18, 2002 to your appropriate EPA
regional office (listed below) or postmarked by the U. S. Postal Service midnight
Wednesday, December 18, 2002.
REGIONAL CONTACT NAMES AND ADDRESSES
Region I Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
Primary Contact: Ronnie Harrington (617) 918-1703
harrington.veronica@epa.gov
USEPA Region 1 (SAA)
1 Congress Street - 11th Floor
Boston, MA 02203-0001
Secondary Contact: PatO'Leary (617)918-1978
oleary. pat@ epa.gov
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
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Region 2
Primary Contact:
Secondary:
New Jersey, New York, Puerto Rico, U.S. Virgin Islands
Terry Wesley (212) 637-3576
wesley.terry@epa.gov
USEPA Region 2
290 Broadway, 26th Floor
New York, NY 10007
Natalie Loney (212) 637-3639
lonev.natalie(5) epa.gov
Region 3
Primary Contact:
Region 4
Primary Contact:
Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia
Reginald Harris (215)814-2988
harris.reggie(5),epa.gov
USEPA Region 3 (3DAOO)
1650 Arch Street
Philadelphia, PA 19103-2029
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, Tennessee
Gloria Love(404) 562-9672
love, gloria@epa.gov
USEPA Region 4
61 Forsyth Street
Atlanta, GA 30303-8960
Secondary:
Cynthia Peurifoy (404) 562- 9649
peurifoy.cvnthia(g) epa.gov
Region 5
Primary Contact:
Secondary:
Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin
Margaret Millard (312) 353-1440
millard.margaret(g) epa.gov
USEPA Region 5 (T-165)
77 West Jackson Boulevard
Chicago, IL 60604-3507
Karla Owens (312) 886-5993
owens.karla(5iepa. gov
Region 6
Primary Contact:
Arkansas, Louisiana, New Mexico, Oklahoma, Texas
Nelda Perez (214) 665-2209
perez. nelda(5) epa. gov
USEPA Region 6
Fountain Place, 12th Floor
1445 Ross Avenue (RA-D)
Dallas, Texas 75202-2733
Secondary Contact:
Olivia Balandran (214) 665-7257
balandran.olivia-r(5) epa. gov
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
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Region 7
Primary Contact:
Secondary
Region 8
Primary Contact:
Secondary:
Region 9
Primary Contact:
Secondary:
Region 10
Primary Contact:
Secondary:
Iowa, Kansas, Missouri, Nebraska
Althea Moses
moses.althea@epa.gov
USEPA Region 7
901 North 5th Street (ECORA)
Kansas City, KS 66101
Monica Espinosa ( 913) 551-7058
espinosa.monicafgjepa. gov
Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
Nancy Reish (303) 312-6040
reish.nancv(5),epa. gov
USEPA Region 8 (8ENF-EJ)
999 18th Street, Suite 300
Denver, CO 80202-2466
Jean Belille (303) 312-6556
belille.ieanfgjepa. gov
Arizona, California, Hawaii, Nevada, American Samoa, Guam
WillardChin (415)972-3797
chin. willard(3j epa. gov
USEPA Region 9 CMD-1
75 Hawthorne Street
San Francisco, CA 94105
Rachael Loftin (415) 972-3272
loftin.rachael@epa. gov
Alaska, Idaho, Oregon, Washington
Cecilia A. Contreras (206)-553-2899
contreras.cecilia(g),epa. gov
USEPA Region 10 (CEJ-163)
1200 Sixth Avenue
Seattle, WA 98101
Victoria Plata (206)553-8580
plata.victoria(g) epa.gov
IV. PROCESS FOR AWARDING GRANTS
A. How Will Applications be Reviewed?
The EPA regional offices will review, evaluate, and select grant recipients. Applications will be
screened to ensure that they meet all eligible activities and requirements described in Sections II
and III. Applications will be disqualified if they do not meet these eligibility standards.
Applications will also be evaluated by regional review panels based on the criteria outlined below.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 12
1. Threshold Criteria. Applications that propose projects that are inconsistent with the EPA's
statutory authority or the goals for the program are ineligible for funding and will not be evaluated
and ranked. Regional offices will contact applicants whose proposals do not meet the threshold
requirements to determine whether the proposal can be revised to meet the threshold
requirements.
2. Evaluation Criteria. Proposals will be ranked using the following criteria:
a. Responsiveness of the Work plan to Environmental Justice issues affecting the
community to be served. ( 20 Points).
b. Effectiveness of the project design. (40 Points).
c. Clarity of the Measures of Success. ( 25 Points).
d. Qualifications of Project Staff ( 15 Points).
B. How Will the Final Selections be Made?
After the individual projects are reviewed and ranked, the EPA regional officials will compare the
best applications and make final selections. Additional factors that the EPA will take into account
include geographic and socioeconomic balance, diverse nature of the projects, cost, and projects
whose benefits can be sustained after the grant is completed. Regional Administrators will select
the final grants.
Please note that this is a very competitive grant's program. Limited funding is available and many
grant applications are expected to be received. Therefore, the Agency cannot fund all applications.
If your project is not funded, a listing of other EPA grant programs maybe found in the Catalog
of Federal Domestic Assistance. This publication is available on the internet at www.cfda.gov and
at local libraries, colleges, or universities.
C. How Will Applicants be Notified?
After all applications are received, the regional EPA offices will mail acknowledgments to
applicants in their regions. Once applications have been recommended for funding, the EPA
Regions will notify the finalists and request any additional information necessary to complete the
award process. The finalists will be required to complete additional government application forms
prior to receiving a grant, such as the EPA Form SF-424B (Assurances - Non-Construction
Programs) and EPA Form 5700-48, the Certification Regarding Debarment, Suspension, and
Other Responsibility Matters. The federal government requires all grantees to certify and assure
that they will comply with all applicable federal laws, regulations, and requirements. The EPA
Regional Environmental Justice Coordinators or their designees will notify those applicants whose
projects are not selected for funding.
V. EXPECTED TIME-FRAME FOR REVIEWING AND AWARDING GRANTS
October 1, 2002 FY 2003 OEJ Small Grants Program Application Guidance
is available and published in the Federal Register.
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October 5, 2002 to
December 18, 2002
December 18, 2002
December 19, 2002 to
February 28, 2003
March 1, 2003 to
July 30, 2003
August 30, 2003
Eligible grant recipients develop and complete their
applications.
Applications must be delivered by close of business
Wednesday, December 18, 2002 to your appropriate EPA
regional office (listed in Section III) or postmarked by
U.S. Postal Service midnight Wednesday, December 18,
2002.
EPA regional program officials review and evaluate
applications and select grant finalists
Applicants will be contacted by the Region if their
application is being considered for funding. Additional
information may be required from the finalists, as indicated
in Section IV. The EPA regional grant offices process
grants and make awards.
EPA expects to release the national announcement of the
FY 2003 Environmental Justice Small Grant Recipients.
VI. PROJECT PERIOD AND FINAL REPORTS
Activities must be completed and funds spent within the time frame specified in the grant award,
one year. Project start dates will depend on the grant award date (most projects begin in August
or September). The recipient organization is responsible for the successful completion of the
project. The qualifications of the recipient's project manager is subject to approval by the EPA
project officer. However, the EPA may not identify any particular person as the project manager.
Unless specified in the award, all recipients must submit final reports for EPA approval within
ninety (90) days of the end of the project period. Specific report requirements (e.g., Quarterly or
Semi-annual Progress Reports, Final Technical Report and Financial Status Report) will be
described in the award agreement. The EPA will collect, review, and disseminate grantees' final
reports to serve as model programs.
For further information about this program, please visit the EPA's website at
http://www. epa. gov/compliance/environmentaliustice/index.html or call our hotline at 1-800-962-
6215 (available in Spanish).
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 14
VII. FISCAL YEAR 2004 ENVIRONMENTAL JUSTICE SMALL GRANTS
PROGRAM
A. How Can I Receive Information on the Fiscal Year 2004 (October 1, 2003 to
September 30, 2004) Environmental Justice Small Grants Program?
If you wish to be placed on the national mailing list to receive information on the FY 2004
Environmental Justice Small Grants Program, email your request along with your name,
organization, address, and phone number to lewis.sheila@epa.gov or mail your request along
with your name, organization, address, and phone number to:
U.S. Environmental Protection Agency
Environmental Justice Small Grants Program (2201 A)
FY 2004 Grants Mailing List
Ariel Rios Building
1200 Pennsylvania Avenue, NW
Washington, D.C. 20460
1 (800) 962-6215
If you wish to receive information on local Environmental Justice programs, you may mail or
email your request along with your name, organization, address, and phone number to the
appropriate regional office listed on pages 9-11 of this application.
Thank you for your interest in our Small Grants Program.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 15
Appendix A Tips on preparing an Environmental Justice Grant Application
This information is intended to help you put together a competitive proposal for the
Environmental Protection Agency's (EPA) Environmental Justice Small Grants Program. Please
read the Application Guidance carefully — this document is intended to enhance not replace the
official FY 03 Guidance.
• Target your audience carefully
Identify a specific group or community to work with to develop a program that will give the
highest return for your dollars invested.
• Build partnerships and alliances
You are strongly encouraged to enlist project involvement from community groups with similar or
related goals and secure their commitment of services and/or dollars. Be sure to document this by
obtaining letter(s) of commitment for your application. Initiate the partnerships early in your
planning, since building alliances can take time and effort.
• Do some homework
Allow time to review the literature on environmental justice issues both within EPA and the
community you work in or with. Find out what materials exist on the subject and the procedures
you are planning to include in your work plan. Use this information to back up your project plans
or to explain how your group activities are unique and/or creative.
• Develop a project evaluation technique
Define as carefhlly and precisely as possible what you want to achieve with this project and how
you will test its success. Ask yourself: "what do you expect to be different once the project is
complete?" Outline a plan you will use to measure the success of your activities/project.
• Develop a timeline or project accomplishment schedule
List the major tasks that you will complete to meet the goals of the project. Break these broad
goals into smaller tasks and lay them out in a schedule over the twelve months of the grant period.
Determine and identify in the proposal the total estimated cost for each task. You may estimate
this cost by the number of personnel, materials, and other resources you will need to carry out the
tasks.
• Develop a project budget with the federal portion up to $15,000 for Multi-Media or
$20,000 for Superfund Research projects
The EPA portion of this grant should not exceed $15,000 for Multi-Media and $20,000 for
Superfund Research projects. Divide your budget into categories such as personnel
salaries/fringe benefits, travel, equipment, supplies, contract costs, other.
-------
Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 16
Appendix A Tips on preparing an Environmental Justice Grant Application
• Stay within the format
This makes it easier for the reviewer to read and therefore, understand your work plan. Please
refer to the application requirements (pages 7 - 9).
• Communicate the nature of your project accurately, precisely, and concisely.
Describe exactly what you propose to do, how you are going to do it, when you are going to do
it, who will benefit, and how you will know you are successful. Indicate not only what you
propose but what expertise your group has for completing the project (include resumes).
EVALUATION OF YOUR PROPOSAL
Your proposal will be evaluated by a committee of EPA Headquarters and Regional
environmental justice personnel of diverse personal and professional backgrounds. Final selection
is based on a variety of factors, including geographic and socioeconomic balance, diversity, cost
of the project and how well the partnership benefits can be sustained after the grant is completed.
Below are some common strengths and weaknesses we see in proposals.
COMMON STRENGTHS
*• Project proposal developed solidly from within the community.
*• Broad based community support for a project that has the potential to positively affect local
people.
*• Project identifies established community advisory board or community group who will be
involved in the project.
*• Good partnership with industry, community, and environmental groups. Good coordination
with a variety of community groups.
> Proposal does a good job of outlining a complex problem and approach to solving it — does
not overlook any major issues or key players.
*• Clear identification and background description of population to be served.
* Proposal identifies specific outputs, target accomplishments, and estimated budgets for each
goal, and target dates for completion.
* Proposed project builds on existing projects or programs.
*• The scope of the project can be completed in a funding year.
* Proposal clearly describes how the project will achieve the program goal(s) outlined on pages 5
and 6 of the application guidance.
* Proposal includes innovative ideas and creative thinking about how to motivate and involve
youth in the communities where they live.
* Proposal includes honest discussion of challenges involved.
If applying for a Superfund project, the proposal discusses why their project is for "research"
to assure it meets statutory requirements.
-------
Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 17
Appendix A Tips on preparing an Environmental Justice Grant Application
COMMON WEAKNESSES
*• Application did not include information specifically requested in the application guidance.
*• Community members do not appear to be an integral part of the project planning process.
* Not specific enough about what EPA funds will be used for. If the proposal is for a project
that has a budget of more than $15,000 for Multi-Media or $20,000 for Superfund Research,
the proposal must indicate whether other funding has been secured.
*• Applicant is not a non-profit organization (see application guidance page 3).
* Program may be too ambitious for one year.
> Project funds conferences or dialogues to discuss EJ issues but does not fund activities that
make direct changes in a community.
*• Immediacy of need is not established.
* Methods of evaluating the success of the project unclear.
* Failure to mention other groups that applicant will work with or to secure letters of
commitment.
* Proposal seeks support for developing general environmental program with little mention of
environmental justice issues. The link between goals of EPA's environmental justice program
and the project is not clearly stated.
*• Discussion of overall mission and goals of the organization but not enough detail on how the
specific project and activities will help achieve the goals.
If you are seeking other sources of funding for your project, or should your EPA application not receive funding, the document below could
prove useful:
Grant Funding For Your Environmental Education Program: Strategies and Options
Prepared by The North American Association for Environmental Education in cooperation with U.S.EPA. Available I Of $5.00 from NAAEE,
Publications Office, P.O. Box 400, Troy, OH 45373
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 18
APPENDIX B - Standard Forms 424 and 424A
Application Packages are available on www.epa.gov/compliance/environmentaliustice/grants
in Adobe pdf format or WordPerfect format. To view the pdf file, you'll need the Adobe Acrobat
plug-in for your browser.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
19
APPLICATION FOR
FEDERAL ASSISTANCE
1. TYPE OF SUBMISSION
Application Preapplication
D Construction D Construction
D Non-Construction D Non-
Construction
2. DATE SUBMITTED Applicant Identifier
3. DATE RECEIVED BY State Application Identifier
STATE
4. DATE RECEIVED BY Federal Identifier
FEDERAL AGENCY
5. APPLICANT INFORMATION
Legal Name:
Address (give city, county, state, and zip code):
6. E
MPLOYER IDENTIFICATION (EIN):
| | -| | ||
8. TYPE OF APPLICATION:
D New D Continuation D Revision
IfR
;vision, enter appropriate letter(s) inbox(es):
A.. Increase Award B. Decrease Award
C. Increase Duration D. Decrease Duration
Other Specify:
10. CATALOG OF FEDERAL DOM ESTIC ASSISTANCE NUMBER:
66.604
TITLE: Environmental Justice Grants to Small Community Groups
12.
13.
AREAS AFFECTED BY PROJECT (cities, counties, states, etc.):
Organizational Unit:
Name and telephone number of the person to be contacted on matters involving
this application (give area code)
7. TYPE OF APPLICANT: (enter appropriate letter here)
A. State H. Independent School District
B. County I. State Controlled Institution of Higher Learning
C. Municipal J. Private University
D. Township K. Indian Tribe
E. Interstate L. Individual
F. Interm unicipal M. Profit Organization
G. Special District N. Other (Specify):
9. NAME OF FEDERAL AGENCY:
1 1. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
PROPOSED PROJECT: 14. CONGRESSIONAL
DISTRICT OF:
Start Date End Date a. Applicant: b. Project
15.
Estimated Funding:
a. Federal $
b. Applicant $
c. State $
d. Local $
e. Other $
f. Program Income $
g. TOTAL $
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER
12372 PROCESS?
a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
TO THE STATE EXECUTIVE ORDER 12372 PROCESSES FOR
REVIEW ON:
DATE
b. NO. D PROGRAM IS NOT COVERED BY E.O. 12372
D OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
D YES If "Yes" attach an explanation. D NO
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Typed Name of Authorized Representative.
b. Title: c. Telephone Number
d. Signature of Authorized Representative e. Date Signed
Previous Editions Not Usable
AUTHORIZED FOR LOCAL REPRODUCTION
Standard Form 424 (REV 7-97)
Prescribed by OMB Circular A-102
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
20
BUDGET INFORMATION - Non-Construction Programs OMB Approval NO. 0343-0044
SECTION A - BUDGET SUMMARY
Grant Program
Function
or Activity
(a)
1.
2.
3.
4.
5. TOTALS
Catalog of Federal
Domestic
Assistance Number
(b)
Estimated Unobligated Funds
Federal
(c)
$
$
Non-Federal
(d)
$
$
New or Revised Budget
Federal
(e)
$
$
Non-Federal
(f)
$
$
Total
(g)
$
$
SECTION B -BUDGET CATEGORIES
6. OBJECT CLASS CATEGORIES
a. Personnel
b. Fringe Benefits
c. Travel
d. Equipment
e. Supplies
f. Contractual
g. Construction
h. Other
i. Total Direct Charges (sum of 6a-h)
j. Indirect Charges
k. TOTALS (sum of 6i and 6j)
GRANT PROGRAM, FUNCTION OR ACTIVITY
(1)
$
$
(2)
$
$
(3)
$
$
(4)
$
$
Total
(5)
$
$
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 424A (Rev. 7-97)
Prescribed by OMB Circular A-102
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
21
SECTION C - NON-FEDERAL RESOURCES
(a) Grant Program
8.
9.
10.
11.
12. TOTAL (sum of lines 8 and 11)
(b) Applicant
$
$
(c) State
$
$
(d) Other Sources
$
$
(e) TOTALS
$
$
SECTION D - FORECASTED CASH NEEDS
13. Federal
14. Non-Federal
1 5. TOTAL (sum of lines 13 and 14)
(Total for IstYear)
$
$
1st Quarter
$
$
2nd Quarter
$
$
3rd Quarter
$
$
4th Quarter
$
$
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
16.
17
18.
19.
20. TOTALS (sum of lines 16 - 19)
FUTURE FUNDING PERIODS (Years)
(b) First
$
$
(c) Second
$
$
(d) Third
$
$
(e) Fourth
$
$
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges:
22. Indirect Charges:
23. Remarks:
SF 424A (7-97)
Page 2
AUTHORIZED FOR LOCAL REPRODUCTION
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 22
INSTRUCTIONS FOR THE SF 424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043), Washington, DC 20503
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS
PROVIDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required face sheet for pre-applications 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.
Item:
1. Self-explanatory.
Entry:
2. Date application submitted to Federal agency (or State if
applicable) & applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new project,
leave blank.
5. 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.
6. Enter Employer Identification Number (EIN) as assigned by
the Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
J'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.
9. Name of Federal agency from which assistance is
being requested with this application.
10. Use the Catalog of Federal Domestic Assistance
number and title of the program under which
assistance is requested.
11. 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.
Item: Entry:
12. 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 organization, 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 7-97) Back
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 23
INSTRUCTIONS FOR THE SF-424A
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collections of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0044), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COM PLETED FORM TO THE OFFICE OF M ANAGEM ENT AND BUDGET. SEND IT TO THE
ADDRESS PROVIDED BY THE SPONSORING AGENCY.
General Instructions
This form is designed so that application can be made for funds
from one or more grant programs. In preparing 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 required Federal authorization in annual or
other funding period increments. In the latter case, Section A,
B, C, and 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 show 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 number in Column (b). For applications pertaining
to multiple 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), (f),
and (g) the appropriate amounts of funds needed to support the
project for the first funding period (usually a year).
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
(f) 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 headings (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 - Show the totals of Lines 6 a to 6h in each column.
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
shown in Section A, Column (g), Line 5. For supplemental
grants and changes to grants, the total amount of the increase
or decrease as shown in Columns (1)-(4), Line 6k should be the
same as the sum of the amounts in Section A, Columns (e) and
(f) on Line 5.
SF424A(7-97)page3
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 24
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
agency 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 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.
Line 13 - 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.
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
SF 424 (7-97) page 4
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 25
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED
2/20/01
Applicant Identifier
1, TYPE OF SUBMISSION
Application
D Construction
3. DATE RECEIVED BY
STATE
State Application Identifier
D
Non-Construction
Preapplication
D Construction
D Non-
Construction
4. DATE RECEIVED BY
FEDERAL AGENCY
Federal Identifier
5, APPLICANT INFORMATION
Legal Name:
G.W. Doe Community Center
Organizational Unit:
Address (give city, county, state, and zip code)
Name and telephone n
involving this applic
G.W. D
(111) 00
er of the person to be contacted on matters
(give area code)
111 Any street
Town, Ohio 00000
6. EMPLO YER IDENTIFICA TION (EIN):
A NT: (ejtfer appropriate letter h ere)
H. Independent School District
I. IStrfe^Colltrolled Institution of Higher
atnm
rivatetUtiiversity
Indian Vr
dividua
P^ofjtJSfganization
"\
the\Specify):
8. TYPE OF APPLICATION:
D New D Continu
D Revisiotfl
If Revision, enter appropriA
A. Increase Awar
C. Increase Durat
Other Specify.
TITLEKJF APPLICANT'S PROJECT
QualKf'Project
10. CATALOG OF FEDERAL DOMESTIGAXS
6.6
^^
TITLE: Environmental Justice\Srants to Small
12. AREAS AFFECTED BY PROU££i»(tities, counties, states, etc.)
City of Town, Ohio
13. PROPOSED PROJECT:
06/01/01
14. CONGRESSIONAL
DISTRICT OF:
Start Da te
06/01/01
End Date
05/31/02
b. Project
01, 02, 03
15. Estimated Funding:
a. Federal
b. Applicant
c. State
d. Local
e. Other
14,958
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER
12372 PROCESS?
a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
TO THE STATE EXECUTIVE ORDER 12372 PROCESSES FOR
REVIEW ON:
DATE
12/20/95
b. NO. D PROGRAM IS NOT COVERED BYE.O. 12372
D OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW
f. Program Income
g. TOTAL
$
14,958
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
D YES If "Yes" attach an explanation. D NO
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COM PLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
Typed Name of Authorized Representative.
G. W. Doe
b. Title:
Executive Director
c. Telephone Number
(111) 000-0000
d. Signature of Authorized Representative
9. TD. <2)oe
e. Date Signed
2/15/01
Previous Editions Not Usable
AUTHORIZED FOR LOCAL REPRODUCTION
Standard Form 424 (REV 7-97)
Prescribed by OMB Circular A-1102
-------
Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
26
BUDGET INFORMATION - Non-Construction Programs
OMB Approval No. 0348-0044
SECTION A - BUDGET SUMMARY
Grant Program
Function
or Activity
Catalog of Federal
Domestic
Assistance
Number
(b)
Estimated Unobligated Funds
New or Revised Budget
Non-Federal
(d)
Non-Federal
(f)
5. TOTALS
6. OBJECT CLASS CATEGORES
a. Personnel
b. Fringe Benefits
d. Equipment
e. Supplies
f. Contractual
g. Construction
i. Total Direct Charges (sum of 6a-h)
j. Indirect Charges
k. TOTALS (sum of o/ and 61
7. Program Income
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 424A (Rev, 7-97)
Prescribed by OMB Circular A-102
-------
Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 27
BUDGETDETAIL
I. Personnel
0.5 FTE Community Outreach Worker @ $10.00/hour $ 3,400.00
0.2 FTE Project Coordinator @ $12.00/hour 1,400.00
0.2 FTE Office Manager @$7.00/hour 1.000.00
5,800.00
II. Frinee Benefits at 17%
0.5 FTE Community Outreach Worker $ 578.00
0.2 FTE Project Coordinator 238.00
0.2 FTE Office Manager 170.00
986.00
III. Travel
Local Travel @ $0.26/mile $ 600.00
IV. Equipment $2,223.00
Audio Visual and Projector Rental
Typewriter/PC
V. Supplies
Paper $ 250.00
Pencils/Pens 100.00
Folders 150.00
500.00
VI. Other $1,700.00
Printing
Postage
Telephone
VII. Contractual $3.149.00
XYZ Engineering Company
Total $14,958.00
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 28
Appendix C 40 CFR 30.27 "Allowable Costs"
Code of Federal Regulations] [Title 40, Volume 1, Part 1 to 49]
[Revised as of July 1, 2000]
From the U.S. Government Printing Office via GPO Access
[CITE: 40CFR30.27] [Page 311]
TITLE 40--PROTECTION OF ENVIRONMENT
CHAPTER I-ENVIRONMENTAL PROTECTION AGENCY
PART 30-UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND
AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND
OTHER NON-PROFIT ORGANIZATIONS-Table of Contents
Subpart C~Post-Award Requirements
Sec. 30.27 Allowable costs.
(a) For each kind of recipient, there is a set of Federal principles for determining allowable
costs. Allowability of costs shall be determined in accordance with the cost principles applicable
to the entity incurring the costs. Thus, allowability of costs incurred by State, local or
federally-recognized Indian tribal governments is determined in accordance with the provisions of
OMB Circular A-87, "Cost Principles for State and Local Governments." The allowability of
costs incurred by non-profit organizations is determined in accordance with the provisions of
OMB Circular A-122, "Cost Principles for Non-Pro fit Organizations." The allowability of costs
incurred by institutions of higher education is determined in accordance with the provisions of
OMB Circular A-21, "Cost Principles for Educational Institutions." The allowability of costs
incurred by hospitals is determined in accordance with the provisions of appendix E of 45 CFR
part 74, "Principles for determining Costs Applicable to Research and Development Under
Grants and Contracts with Hospitals." The allowability of costs incurred by commercial
organizations and those non-profit organizations listed in Attachment C to Circular A-122 is
determined in accordance with the provisions of the Federal Acquisition Regulation (FAR) at 48
CFR part 31. In addition, EPA's annual Appropriations Acts may contain restrictions on the use
of assistance funds. For example, the Acts may prohibit the use of funds to support intervention in
Federal regulatory or adjudicatory proceedings.
(b) EPA will limit its participation in the salary rate (excluding overhead) paid to individual
consultants retained by recipients or by a recipient's contractors or subcontractors to the
maximum daily rate for level 4 of the Executive Schedule unless a greater amount is authorized by
law. (Recipient's may, however, pay consultants more than this amount.) This limitation applies to
consultation services of designated individuals with specialized skills who are paid at a daily or
hourly rate. This rate does not include transportation and subsistence costs for travel performed;
recipients will pay these in accordance with their normal travel reimbursement practices.
Contracts with firms for services which are awarded using the procurement requirements in this
part are not affected by this limitation.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 29
Appendix D GUIDANCE ON LOBBYING RESTRICTIONS
The purpose of this guidance is to remind nonprofit organizations, universities, and other non-
government recipients of EPA grants1 that, with very limited exceptions, you may not use Federal
grant funds or your cost-sharing funds to conduct lobbying activities. The restrictions on lobbying
are explained in Office of Management and Budget (OMB) Circular No. A-21, "Cost Principles
for Educational Institutions," 61 Fed. Reg. 20880 (May 8, 1996),2 and OMB Circular No. A-122,
"Cost Principles for Nonprofit Organizations; 'Lobbying' Revision," 49 Fed. Reg. 18260 (April 27,
1984). As a recipient of EPA funds, you must be aware of and comply with these restrictions.3
The general objective of the restrictions is to prohibit the use of appropriated funds for lobbying,
publicity, or propaganda purposes designed to support or defeat legislation. The restrictions do
not affect the normal sharing of information or lobbying activities conducted with your own funds
(so long as they are not used to match the grant funds).
Unallowable Lobbying Activities
Under Circulars A-21 and A-122, the costs of the following activities are unallowable:
(1) Contributions, endorsements, publicity or similar activities intended to influence
Federal, State or local elections, referenda, initiatives or similar processes.
(2) Direct and indirect financial or administrative support of political parties, campaigns,
political action committees, or other organizations created to influence elections. Recipients may
help collect and interpret information. These efforts must be for educational purposes only,
however, and cannot involve political party activity or steps to influence an election.
The term "grant" as used in this guidance refers to grants and cooperative agreements.
Grants awarded before May 8, 1996, are subject to the previous version of Circular No. A-
21, but the provisions on lobbying have remained essentially unchanged.
This guidance does not address the restrictions on lobbying contained in 40 CFR Part 34, the
EPA regulations implementing section 319 of P.L. No. 101-121, known as "the Byrd
Amendment," generally prohibit recipients of Federal grants, contracts, and loans from using
Federal funds for lobbying the Executive or Legislative Branches of the Federal Government in
connection with a specific grant, contract, or loan. Part 34 includes detailed certification and
disclosure requirements. This guidance also does not address section 18 of the Lobbying
Disclosure Act of 1995, P.L. No. 104-65, which provides that organizations described in section
501(c)(4) of the Internal Revenue Code that engage in lobbying activities are not eligible for
Federal grants or loans.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 30
Appendix D GUIDANCE ON LOBBYING RESTRICTIONS
(3) Attempts to influence the introducing, passing, or changing of Federal or State
legislation through contacts with members or employees of Congress or State legislatures,
including attempts to use State and local officials to lobby Congress or State legislatures. For
example, you may not charge a grant for your costs of sending information to Members of
Congress to encourage them to take a particular action. Also prohibited are contacts with any
government official or employee to influence a decision to sign or veto Federal or State
legislation. The restriction does not address lobbying at the local level.
(4) Attempts to influence the introducing, passing, or changing of Federal or State
legislation by preparing, using, or distributing publicity or propaganda, i.e., grass roots lobbying
efforts to obtain group action by members of the public, including attempts to affect public
opinion and encourage group action. For example, the costs of printing and distributing to
members of the public or the media a report produced under a grant, if intended to influence
legislation, are unallowable.4
(5) Attending legislative sessions or committee hearings, gathering information about
legislation, and similar activities, when intended to support or prepare for unallowable lobbying.
Exceptions
There are three exceptions to this list of unallowable lobbying activities in Circulars A-21
and A-122. These exceptions do not necessarily make the cost of these activities allowable; they
make the costs potentially allowable. Allowability will be determined based on whether the costs
in a particular case are reasonable, necessary, and allocable to the grant.
The first exception is for technical and factual (not advocacy) presentation to Congress, a
State legislature, member, or staff, on a topic directly related to performance of the grant, in
response to a request (not necessarily in writing) from the legislative body or individual. For
requests that are not made in writing, recipients should make a note for their files documenting
the requests. The information presented must be readily available and deliverable. Costs for
travel, hotels, and meals related to the presentation are generally unallowable unless related to
testimony at a regularly scheduled Congressional hearing at the written request of the chairperson
or ranking minority member of the congressional committee.
\5\ Circular A-122 addresses public information service costs that do not relate to lobbying.
Attachment B to the Circular, at paragraph 36, makes allowable, with prior approval of the
Federal agency, costs associated with pamphlets, news releases and other forms of information
services if their purpose is: to inform or instruct individuals, groups or the general public; to
interest individuals or groups in participating in a service program of the recipient; or to
disseminate the results of sponsored and non-sponsored activities.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 31
Appendix D GUIDANCE ON LOBBYING RESTRICTIONS
The second exception is for actions intended to influence State legislation in order to
directly reduce the actual cost of performing the Federal grant project or to protect the recipient's
authority to perform the project. The exception does not apply to actions intended merely to shift
costs from one source to another. For example, in response to Federal funding cutbacks, a
Federally-funded recipient lobbies for State funds to replace or reduce the Federal
share of project costs for next year. The cost of that lobbying activity would not be allowable
because its purpose is not to directly reduce the actual cost of performing the work but merely to
shift from Federal funding to State funding.
Finally, Circulars A-21 and A-122 allow lobbying costs if they are specifically authorized
by law.
Indirect Cost Rate
When you seek reimbursement for indirect costs (overhead), you must identify your total
lobbying costs in your indirect cost rate proposal so that the Government can avoid subsidizing
lobbying. This is consistent with the circulars' requirement of disclosure of the costs spent on all
unallowable activities. This requirement is necessary so that when the Government calculates the
amount of an organization's indirect costs that it will pay. It does not include the costs of
unallowable activities that the organization happens to count as indirect costs
Enforcement
In cases of improper lobbying with grant funds, EPA may recover the misspent money,
suspend or terminate the grant, and take action to prevent the recipient from receiving any Federal
grants for a certain period. Your project officer is available to handle any questions or concerns.
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
32
Appendix E
State Single Points of Contact
Your application to this EPA program may be subject to your state's inter-governmental review
process and/or consultation requirements under Section 204, Demonstration Cities and
Metropolitan Development Act. Listed below are the Single Point-of-Contacts for the states and
U.S. territories with a designated Single Point-of-Contact. Please check the list to see if such
review is required in your state or territory. Those stated and U.S. territories that are not listed
do not have an established single point-of-contact. For further information regarding Single
Points-of-Contact, please call EPA at 202-564-5362. Please also note that federally recognized
tribal organizations are not required to comply with this procedure.
ARIZONA
Ms. Joni Saad
Arizona State Clearinghouse
3800 North Central Avenue
Fourteenth Floor
Phoenix, AZ 85012
Phone: 602.280.1315
Fax: 602.280.8144
ARKANSAS
Mr. Tracy L. Copeland, Manager
State Clearinghouse
Office of Intergovernmental Services
Department of Finance and Administration
1515 West Seventh Street, Room 412
Little Rock, AR 72203
Phone: 501.682.1074
Fax: 501.682.5206
tlcopeland(a),dfa. state, ar. us
CALIFORNIA
Grants Coordinator
Office of Planning and Research
1400 Tenth Street, Room 121
Sacramento, CA 95814
Phone: 916.323.7480
Fax: 916.323.3018
DELAWARE
Charles H. Hopkins
Executive Department
Office of Budget
540 S. Dupont Highway, 3rd Floor
Dover, DE 19901
Phone: 302.739.3323
Fax: 302.739.5661
chopkins(a}state.de.us
DISTRICT OF COLUMBIA
Luisa Montero-Diaz
Office of Partnerships and Grants Development
Executive Office of the Mayor
District of Columbia Government
441 4th Street, NW, Suite 530 South
Washington, D.C. 20001
Phone: 202.727.8900
Fax: 202.727.1652
opgd. eom (flldc.gov
FLORIDA
Jasmine Raffington
Florida State Clearinghouse
Department of Community Affairs
2555 Shumard Oak Blvd.
Tallahassee, FL 32399-2100
Phone: 850..922.5438
Fax: 850.414.0479
clearinghouse(a),dca.state.fl. us
GEORGIA
Mr. Tom Reid, III, Coordinator
Georgia State Clearinghouse
270 Washington Street, SW, Eighth Floor
Atlanta, GA 30334
Phone: 404.656.3855
Fax: 404.656.7901
gach(a}mail.opb. state, ga.us
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
33
ILLINOIS
Ms. Virginia Bova
Single Point of Contact
Department of Commerce and Community Affairs
James R. Thompson Center
100 West Randolph, Suite 3-400
Chicago, IL 60601
Phone: 312.814.6028
Fax: 312.814.8485
vbova(a),commerce. state, il.us
INDIANA
Ms. Frances E. Williams
State Budget Analyst
212 State House
Indianapolis, IN 46204
Phone: 317.232.5619
Fax: 317.233.3323
IOWA
Mr. Steven R. McCann
Division for Community and Rural Development
Iowa Department of Economic Development
200 East Grand Avenue
Des Moines, IA 50309
Phone: 515.242.4719
Fax: 515.242.4809
steve.mccann(a),ided.state.ia.us
MAINE
Ms. Joyce Benson
State Planning Office
184 State Street
38 State House Station
Augusta, ME 04333
Phone: 207.284.3261
Fax: 207.284.6489
Joyce.ben son(8),state. me. us
MARYLAND
Linda Janey, Manager
Clearinghouse and Plan Review Unit
Maryland Office of Planning
301 West Preston Street, Room 1104
Baltimore, MD 21201-2305
Phone: 410.767.4490
Fax: 410.767.4480
linda(a),mail. op. state, md.us
MICHIGAN
Mr. Richard Pfaff
Southeast Michigan Council of Governments
535 Griswold, Suite 300
Detroit, MI 48226
Phone: 313.961.4266
Fax: 313.961.4869
pfaff(a),semocog. org
KENTUCKY
Mr. Ronald W. Cook
Office of the Governor
Department of Local Government
1024 Capital Center Drive, Suite 340
Frankfort, KY 40601-8204
Phone: 502.573.2382
Fax: 502.573.2512
ron.cook(a),mail.state.kv.us
LOUISIANA
Ms. Theresa Stevens
Executive Management Officer
Louisiana Department of Environmental Quality
P.O. Box 82231
Baton Rouge, LA 70884-2231
Phone: 225.7655.0733
MISSISSIPPI
Ms. Cathy Mallette, Clearinghouse Officer
Department of Finance and Administration
1301 Woolfolk Building, Suite E
501 North West Street
Jackson, MS 39201
Phone: 601.359.6762
Fax: 601.359.6758
MISSOURI
Ewell Lawson
Federal Assistance Clearinghouse
Office of Administration
P.O. Box 809
Truman Building, Room 840
Jefferson City, MO 65102
Phone: 573.751.4834
Fax: 573.522.4395
igr(a),mail.oa.state. mo.us
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
34
NEVADA
Heather Elliott
Department of Administration
State Clearinghouse
209 E. Musser Street, Room 200
Carson City, NV 89701
Phone: 775.684.0209
Fax: 775.684.0260
heHiott(a),govmail.state.nv.us
RHODE ISLAND
Kevin Nelson
Department of Administration
Statewide Planning Program
One Capitol Hill
Providence, RI 02908-5870
Phone: 401.222.2093
Fax: 401.222.2083
knelson(a),doa. state, ri.us
NEW HAMPSHIRE
Mr. Jeffery H. Taylor, Director
New Hampshire Office of State Planning
Attn: Intergovernmental Review Process
2 1A Beacon Street
Concord, NH 03301
Phone: 603.271.2155
Fax: 603.271.1728
itaylor(a),oosp.state.nh. us
SOUTH CAROLINA
Omegia Burgess
Budget and Control Board
Office of State Budget
1122 Ladies Street, 12th Floor
Columbia, SC 29201
Phone: 803.734.0494
Fax: 803.734.0645
aburgess(a),budget.state.s.us
NEW MEXICO
Mr. Ken Hughes
Local Government Division
Bataan Memorial Building, Room 201
Santa Fe, NM 87503
Phone: 505.827.4370
Fax: 505.827.4948
khughes(a),dfa. state, nm.us
NEW YORK
New York State Clearinghouse
Division of the Budget
State Capital
Albany, NY 12224
Phone: 518.474.1605
Fax: 518.486.5617
NORTH CAROLINA
Jeanette Furney
Department of Administration
1302 Mail Service Center
Raleigh, NC 27699-1302
Phone: 919.807.2323
Fax: 919.733.9571
ieanette.furney(a),ncmail.net
TEXAS
Denise S. Francis
Director, State Grants Team
Governor's Office of Budget and Planning
P.O. Box 12428
Austin, TX 78711
Phone: 512.305.9415
Fax: 512.936.2681
dfrancis(a),governor.state.tx. us
UTAH
Carolyn Wright
Utah State Clearinghouse
Governor's Office of Planning and Budget
State Capitol, Room 114
Salt Lake City, UT 84114
Phone: 801.538.1535
Fax: 801.538.1547
cwright(Sigov. state, ut. us
WEST VIRGINIA
Fred Cutlip, Director
Community Development Division
West Virginia Development Office
Building #6, Room 553
Charleston, WVA 25305
Phone: 304.558.4010
Fax: 304.552.3248
fcutlip(a>,wvdo.org
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003
35
WISCONSIN
Jeff Smith
Section Chief, Federal/State Relations
Wisconsin Department of Administration
101 East Wilson Street - 6th Floor
P.O. Box 7868
Madison, WI 53707
Phone: 608.266.0267
Fax: 608.267.6931
ieffrey.smith(Sidoa. state, wi.us
VIRGIN ISLANDS
Ira Mills, Director
Office of Management and Budget
#41 Norre Gade Emancipation Garden Station
Second Floor
Saint Thomas, VI 00802
Phone: 340.774.0750
Fax: 340.776.0069
Irmills@usvi.org
AMERICAN SAMOA
Pat M. Galea'i
Federal Grants/Programs Coordinator
Office of Federal Programs
Office of the Governor/Department of Commerce
American Samoa Government
Pago Pago, American Samoa 96799
Phone: 684.633.5155
Fax: 684.633.4195
pmgaleai(3j samoatelco. com
GUAM
Director
Bureau of Budget and Management Research
Office of the Governor
P.O. Box 2950
Agana, Guam 96910
Phone: 011.671.472.2285
Fax: 011.472.2825
jer@ns.gov.gu
PUERTO RICO
Jose Caballero/Myra Silva
Puerto Rico Planning Board
Fedral Proposal Review Office
Minillas Government Center
P.O. Box 41119
San Juan, Puerto Rico 00940-1119
Phone: 787.723.6190
Fax: 787.722.6783
NORTH MARIANA ISLANDS
Ms. Jacoba T. Seman
Federal Programs Coordinator
Office of Management and Budget
Office of the Governor
Saipan, MP 96950
Phone: 670.664.2289
Fax: 670.664.2272
omb. iseman(Sjsaipan. com
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Office of Environmental Justice Small Grants Program - Application Guidance FY 2003 36
Appendix F
ADDITIONAL GOVERNMENT APPLICATION FORMS
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OMB Approval No. 0348-0040
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Sendcomments regarding the
burden estim ate or any other aspect of this collection of inform ation, including suggestions for reducing this burden, to the Office of Management and Budget,
Paperwork Reduction Project (0348-0040), W ashington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY
THE SPONSORING AGENCY.
l\OtC. 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 the project costs) to ensure
proper planning, management and completion 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 statues 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
sex; (c) Section 504 of the Rehabilitation Act of
1973, as amended (29 U.S.C. § 795), which prohibits
discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C.
§§ 6101-6107), which prohibits discrimination on the
basis of age;
e) the Drug Abuse Office and Treatment Act of 1972
VP.L. 92-255), as amended, relating to nondiscrimination
of the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse ana Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970 (P.L. 91-616), as
amended, relating to nondiscrimination on the basis of
alcohol abuse or alcoholism; (g) §§ 523 and 527 of the
Public Health Service Act of 1912 (42 U.S.C. 290 dd-3
and 290 ee-3), as amended, relating to confidentiality of
alcohol and drug abuse patient records; (h) Title VIII of
the Civil Rights Act of 1968 (42 U.S.C. § 3601 et seq.),
as amended, relating to nondiscrimination in the sale,
rental or financing of housing; (h any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
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 provision of the Hatch Act (5
U.S.C. §f 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. §§ 276a-7), the
Copeland Act (40 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.
Previous Edition Usable
Standard Form 424B (7-97)
Prescribed by OMB Circular A-102
AUTHORIZED FOR LOCAL REPRODUCTION
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10. Will comply, if applicable, with flood insurance 13.
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 and to 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 14.
be prescribed 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 pursuance to EO 11738; (c) 15.
protection of wetlands pursuant to EO 11990; (a)
evaluation of flood hazards in floodplain 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.V (f) conformity of Federal actions to State (Clear 16.
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 17
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 13
1968 (16 U.S.C. §§ 1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
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-1
et seq.)
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.
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.
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.
Will cause to be performed the required financial and
compliance audits in accordance with the Single
Audit Act of 1984.
Will comply with all applicable requirements of all
other Federal laws, executive orders, regulations and
policies governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING
OFFICIAL
TITLE
APPLICANT ORGANIZATION
DATE SUBMITTED
Standard Form 424B (Rev 7-97) Back
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U.S. Environmental Protection Agency
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY
MATTERS
The prospective participant certifies to the best of its knowledge and belief that it and its
principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
(b) Have not within a three year period preceding this proposal been convicted of or had a
civil judgement rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal,
State, or local) transaction or contract under a public transaction; violation of Federal
or State antitrust statutes or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statements, or receiving stolen
property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a
government entity (Federal. State, or ocal) with commission of any of the offenses
enumerated in paragraph (l)(b) of this certification; and
(d) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State, or local) terminated for cause or default.
I understand that a false statement on this certification may be grounds for rejection of this
proposal or termination of the award. In addition, under 18 USC Sec. 1001, a false
statement may result in a fine of up to $10,000 or imprisonment for up to 5 years, or both.
Typed Name & Title of Authorized Representative
Signature of Authorized Representative Date
I am unable to certify to the above statements. My explanation is attached.
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