Environmental Justice
Small Grants
Program
Application Guidance
FY 2005
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United States Enforcement and February 2005
Environmental Protection Compliance Assurance
Agency (2201A)
Office of Environmental Justice
http://www.epa.gov/compliance/environmentaliustice/arants/ei smarants.html
inside front cover
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
OVERVIEW INFORMATION
A. Required Overview Content
1. Federal Agency Name: U.S. Environmental Protection Agency, Office of
Environmental Justice
2. Funding Opportunity Title: Environmental Justice Small Grants Program
3. Announcement Type: Initial Announcement
4. Funding Opportunity No.: N/A
5. CFDA No.: 66.604
6. Dates: February 18, 2005 - April 4, 2005
This funding opportunity will be open from February 18, 2005 to April 4, 2005. The
deadline for submission of completed application packages is April 4, 2005.
Applications must be date stamped by courier service or postmarked by the U.S.
Postal Service by midnight, Monday, April 4, 2005.
B. Optional, Additional Overview Content
1. Concise Description of Funding Opportunity
This document solicits grant applications from eligible community-based organizations
to support projects that address a community's exposure to multiple environmental
harms and risks. To be eligible to receive financial assistance, community-based
organizations must be non-governmental, not-for-profit 501(c)(3) organizations located
in the affected community.
The focus for this year's Environmental Justice Small Grants Program is collaborative
partnerships. Each applicant must demonstrate collaboration between local
community-based organizations and others (industry, federal, state and local
governments, academia, and environmental organizations) to realize their project goals
and objectives.
This program will fund two kinds of projects: Comprehensive Environmental Response,
Compensation, and Liability Act (CERCLA research) and multi-media.
a. CERCLA (hazardous substance research only)
Recipients of CERCLA research grants must implement projects that are
specifically research oriented and specific to hazardous substances.
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b. Multi-media (research or other activities as allowed by statute)
These projects must address pollution in more than one environmental medium
(e.g., land, 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 environmental statutes found in Section III, C, 2.
This solicitation notice contains all the information and forms necessary to prepare a
proposal. If your project is selected as a finalist after the evaluation process is
concluded, EPA will provide you with additional federal forms needed to process your
proposal.
C. Total Amount to be Awarded:
During fiscal year (FY) 2005 (October 1, 2004 - September 30, 2005), the EPA will
make available $750,000 in grant funds to local community-based organizations.
Translations Available
The Spanish translation of this application is available at 1-800-952-6215. It can also
be downloaded at:
http://www.epa.aov/compliance/environmentaliustice/arants/ei smgrants.html
This guidance includes the following:
I.
Funding Opportunity Description
II.
Award Information
III.
Eligibility Information
IV.
Application and Submission Information
V.
Application Review Information
VI.
Award Administration Information
VII.
Agency Contact(s)
VIII.
Other Information
Application Package Checklist
Appendix A: Application Forms, Completed Sample Forms and Budget Detail
Appendix B: 40 CFR 30.27 "Allowable Costs".
Appendix C: Guidance on Lobbying Restrictions
Appendix D: Environmental Results Under Assistance Agreements Template
Appendix E: Key Contacts Form
Appendix F: Checklist for Determining Eligibility for CERCLA and Multi-Media Funding
Appendix G: Quality Assurance Project Plan Checklist
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SECTION I - Funding Opportunity Description
A. OVERVIEW
1. Scope of the Environmental Justice Small Grants Program
The Environmental Protection Agency's Office of Environmental Justice (OEJ)
established the Environmental Justice Small Grants Program in FY 1994. The purpose
of this grant program is to provide financial assistance that will support and empower
community-based organizations that are working on local solutions to local
environmental and/or public health problems.
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
2003
858,907
55
2004
423,545
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Summaries of all the Environmental Justice Small Grants funded in FY 2004 and prior
years are available on the OEJ website at
http://www.epa.aov/compliance/environmentaliustice/arants/ei smgrants.html.
2. Environmental Justice Defined 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, or income with respect to the development,
implementation, and enforcement of environmental laws, regulations, and policies. Fair
treatment means that no group of people, including racial, ethnic, or socioeconomic
group, 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) the 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
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
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out and facilitate the involvement of those potentially affected.
3. Purpose
a. Address Local Environmental and/or Public Health Issues
The purpose of this grant program is to provide financial assistance that will
support and empower community-based organizations that are working on local
solutions to local environmental and/or public health problems. In addition, the
applicant must demonstrate the ability to form collaborative partnerships
(industry, federal, state and local governments, academia, and environmental
organizations) and the ability to work with these collaborative partners in
addressing local environmental and/or public health issues. See below for more
details on collaborative partnerships.
b. Create Collaborative Partnerships
Collaboration is a process through which parties who see different aspects of a
problem can constructively explore their differences and search for solutions that
go beyond their own limited vision of what is possible. The focus for this year's
Environmental Justice Small Grants Program is collaborative partnerships. For
the FY 2005 grant opportunity, the applicant's ability to build partnerships and
work with them to address local environmental and/or public health issues is
required. Building a successful collaborative partnership requires vision, clear
problem identification, organizational capacity and commitment, and individual
leadership. This is an evolving process that grows from existing capacity on the
part of the affected community as well as other stakeholder groups. For
example, community groups may need support in accessing government
resources while industry may need education on how to work effectively and pro-
actively with communities. Several ways to achieve well structured multi-
stakeholder collaborative partnerships include:
(1) Establishing dialogues which lead to possible partnerships with all
relevant stakeholders/parties, which invariably include the community,
business, and government;
(2) Ensuring clarity of goals, objectives, and a common vision among all
members of the partnership;
(3) Developing a clear, workable organizational structure and workplan to
address communications and coordination needs of the collaborative
partnership;
(4) Identifying and recruiting partners to address the resource needs of a
project (e.g., human, institutional, technical, legal, and financial);
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(5) Strengthening partnerships as new issues and relationships are
understood;
(6) Establishing processes that allow for the inclusion of new partners as they
emerge; and
(7) Regularly sharing the outcomes of the project's collaborations with the
impacted community via public meetings, newspaper articles, radio, etc.
during the grant period, to encourage future collaborations.
4. Type of Projects to be Funded
For FY 2005, projects will be awarded using two sources of funding (CERCLA and
multi-media). There are specific limitations placed on projects depending on the
funding source. For instance, CERCLA projects are limited to research projects specific
to hazardous waste, while multi-media projects can be research, survey, study,
demonstration, or investigation. For more information on eligibility and limitations, see
Section III, C.
a. CERCLA (hazardous substance research only)
Recipients of CERCLA research grants must implement projects that are
specifically research oriented and specific to hazardous substances.
b. Multi-media (research or other activities as allowed by statute)
These projects must address pollution in more than one environmental medium
(e.g., land, 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 environmental statutes found in Section III, C, 2.
5. Environmental Results
All applicants are required to link their projects to environmental results. Environmental
results are used as a way to gauge a project's performance using output and outcome
measures. The term "output" means an environmental activity, effort, and/or associated
work product related to an environmental goal or objective, that will be produced or
provided over a period of time or by a specific date. The term "outcome" means an
environmental result, effect or consequence that will occur from carrying out an
environmental program or activity that is related to an environmental or programmatic
goal or objective. To illustrate, an output would be the number of buses retro-fitted;
while an outcome would be the decrease in the percentage of children suffering from
asthma as a result of cleaner air.
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Environmental results not only assess the success of an applicant's project, they also
gauge the effectiveness of EPA's programs by ensuring that EPA's limited resources
are used to further the Agency's Strategic Goals. The Strategic Goal for the
Environmental Justice Small Grants Program is:
For more information on EPA's Strategic Plan go to:
http://www.epa.aov/ocfopaae/plan/plan.htm
Therefore, all proposed projects must demonstrate how they will result in healthy
communities and ecosystems. As part of the application, you will be required to
complete the "Environmental Results in Assistance Agreements" template (See
Appendix D).
The total amount of funding available for this program is approximately $750,000 in
grant funds to eligible organizations (pending availability of funds). Each award will be
made in the form of a federal grant in the amount of $25,000 to be used over a one
year period. Each Region will receive $75,000 to support local projects. From the
$75,000, one CERCLA research project ($25,000) and two multi-media projects
($25,000 each) will be awarded from each Region. The total project cost for each
project must be exactly $25,000. Please note that multi-media projects and CERCLA
research projects have different requirements (See Section III, C). Therefore, you
should be careful in drafting your proposal to ensure that your proposed project meets
those requirements. You should clearly specify in your grant proposal the type of
project (multi-media or CERCLA research) that you propose to conduct. Activities must
be completed and funds spent within the one year period specified in the grant award,
absent EPA approval. 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.
If you have received a grant from this program in the past, it is essential that you
explain how your current proposal is different. This grant cannot be used to continue
the activities in a previous project and is not intended to supplement existing projects.
Additionally, the Environmental Justice Small Grants Program is a competitive grant
program. Every eligible application for FY 2005 will be evaluated based on the merits
Goal 4:
Objective 4.2:
Healthy Communities and Ecosystems
Sustain, Clean-up, and Restore Communities and the
Ecological Systems that Support Them
Restore Community Health
Sub-objective 4.2.2:
SECTION II - Award Information
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of the proposed project in comparison to other eligible FY 2005 applications.
Applicants may not receive federal funding from more than one source for the
same activities outlined in the grant application workplan.
SECTION III - Eligibility Information
A. ELIGIBLE APPLICANTS
1. Eligibility requirements
An applicant must meet all of the requirements listed and must identify how it fits each
of those requirements in the application. An applicant must be a non-government, not-
for-profit 501(c)(3) local community-based organization.
An affected local community-based organization (LCBO) is defined as being in the
locale which is influenced or altered by the environmental/public health problem and for
this grant program as an entity/organization that is:
(1) located in the same area as the environmental and/or public health problem that is
described in the application and where the residents of the affected community reside;
(2) comprised of members of the affected community;
(3) focused primarily on addressing the environmental and/or public health problems of
the residents of the affected community; and
(4) at the most basic level of the organizational hierarchy such as a grassroots
group/neighborhood organization that is not affiliated with a larger national, regional or
state organization.
2. Ineligible applicants
The following is a list of entities ineligible to be a recipient under this grant program:
(1)
Individuals;
(2)
Universities;
(3)
State governments;
(4)
Local governments;
(5)
Tribal governments;
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(6) Water districts or similar entities;
(7) Large non-governmental organizations such as national environmental groups;
(8) Environmental justice networks;
(9) Local chapters of large non-governmental organizations or networks and
(10) Organizations that are not located in the affected communities where the
projects are found.
B. COST SHARING OR MATCHING
The award will be $25,000 in EPA funds. Cost sharing or matching is NOT required.
C. OTHER ELIGIBILITY CRITERIA
1. Eligible Projects
CERCLA projects are limited to research projects specific to hazardous waste, while
multi-media projects can include research or other activities that are allowed under the
applicable statute (See below). Please note that a project funded as either CERCLA or
multi-media can be research. See below for project specific requirements for CERCLA
research and multi-media projects. Each Region has the discretion to fund a project
using either of the funding sources (CERCLA or multi-media) if it is determined that the
project can fit under both programs (See Appendix F for more information). Please
note that even if an applicant qualifies under both programs, it can only be awarded
ONE grant if selected.
a. What is Research?
The definition of research is applicable to both CERCLA research projects and
multi-media projects that are research in nature. 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 and the "natural" sciences.
These projects are to support and empower community-based organizations to
do research on environmental harms and risks associated with exposure to
multiple stressors. Sources of harms and risks may include multiple industrial
facilities and the various contaminants they emit, environmental hazards at the
workplace or home, transportation-related pollution, concerns about consumption
of contaminated drinking water, fish or other subsistence food. These situations
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may occur in urban, suburban, rural or tribal settings. One goal of this program is
to help communities identify and understand the many environmental and/or
public health concerns that may exist. Research should take into account the
multiple impacts of various pollutants in the communities' environment. In
environmentally overburdened low-income, minority or tribal communities,
research that focuses on the impacts from multiple environmental harms and
risks can greatly assist communities in understanding their environmental
problems and developing more effective solutions to their environmental and/or
public health concerns. The research may become a catalyst for reducing
exposure to or reducing the health impact from environmental stressors in the
communities. (See Section VI, E and Appendix G for more information about
the requirement for a Quality Assurance Project Plan for research projects.)
b. What Kind of Project Can Be Funded Under Multi-media Funding?
The projects under this category are less restrictive than those funded under
CERCLA and are open to a variety of different categories. Projects can be
research or other kinds of activities allowable by statute. The only limitation is
that it must address an environmental and/or public health issue involving
two or more applicable statutes (See below).
(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
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studies on toxic substances
(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.
c. What Kind of Projects Can Be Funded Under CERCLA Funding?
Recipients of CERCLA research grants must implement projects that are
specifically research oriented and specific to hazardous substances (i.e., survey,
research, collecting and analyzing data). For a detailed definition of "research"
see Section III, C, 1, a. Under CERCLA, your research project MUST meet the
following criteria:
(1) CERCLA, Section 311(c) authorizes EPA to fund research grants.
Therefore, Superfund grants can only be awarded when the project is of a
research nature. 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 311 (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; they may expand the
scientific knowledge or understanding of a community about hazardous
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substances issues that effect their community.
(5) The project cannot carry out training activities, other than training in
research techniques. In other words, CERCLA 311(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 produced as part of this funded
project or to gather research data.
2. Ineligible Projects
Projects ARE NOT ELIGIBLE TO BE FUNDED under this grant program that would:
(1) Conduct health surveys unrelated to a specific environmental and/or public
health issue; or
(2) Conduct human health testing.
SECTION IV - Application and Submission
Information
A. ADDRESS TO REQUEST APPLICA TIONS
1. Request for Applications (RFA)
FY 2005 Environmental Justice Small Grants Program's Request for Applications
is available electronically on www.fedarants.aov and
http://www.epa.aov/compliance/environmentaliustice/arants/ei smgrants.html .
Hard copies are available upon request by contacting your regional office listed
in Section VII.
2. Application Forms
To download the required applications forms (See Section IV, B below) go to the
following web-site at: http://www.epa.aov/oad/AppKit/application.htm.
3. Federal Grants Regulations
To get more information on Federal regulations governing grants management
go to the following web-site at:
http://www.epa.aov/oad/arants/how to applv.html
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B. CONTENT AND FORM OF APPLICA TION SUBMISSION
Proposals from eligible organizations must have the following:
(1) The Application for Federal Assistance (SF 424) is the official form required
for all federal grants that requests basic information about the grantee and the
proposed project. The applicant must submit the original application form, 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. Grant applicants are required
to provide a Dun and Bradstreet (D&B) Data Universal Numbering System
(DUNS) number when applying for Federal grants. Organizations can
receive a DUNS number in one day, at no cost, by calling the dedicated toll-
free DUNS Number request line at 1-866-705-0025. The website where an
organization can obtain a DUNS number is: http://www.dnb.com. See Appendix
A for a copy of Form 424 and a completed sample.
(2) The Federal Standard Form (SF 424A) which provides information on your
budget. For the purposes of this grant program, complete only the non-
shaded areas of SF 424A.
(3) A detailed budget with estimates that support your work plan narrative. See
Appendix A for a sample of a detailed budget.
(4) A work plan narrative not to exceed five (5) pages which describes the
applicant's proposed project. The pages of the work plan must be letter size (8
1/4 x 11 inches), with normal type size (12 characters per inch), and at least 1 inch
margins. The work plan narrative 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 identifies the following:
1. Environmental and/or public health concerns to be addressed by
the project;
2. The community/target audience;
3. The project goal(s) and how the goals will be achieved;
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4. Applicable environmental statute(s) (CERCLA or statutes listed
under Section III, C, 1, b).
b. A concise introduction that states:
1. The nature of the organization (i.e., how long it has been in
existence and how the applicant meets the definition of an affected
local community-based organization);
2. How the organization has been successful in the past on other
projects;
3. The type (CERCLA research or multi-media) and purpose of the
project (i.e., what do you hope to accomplish by undertaking the
project);
4. Detailed characteristics of the affected community/target audience
(racial, ethnic and socioeconomic);
5. Project's completion plans/time-frames; and
c. A concise project description that includes:
1. The details of the specific environmental and/or public health
issues to be addressed; and
2. An implementation plan that describes in chronological order the
activities you will undertake to carry out this project.
d. A concise description of the collaborative partnership(s) that
include:
1. How the collaborative partners will participate in the project;
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2. The strategies for cooperation and communication with the
identified collaborative partners;
3. The specific steps you have and/or will undertake to engage in
constructive engagement among collaborative partners; and
4. How you plan to maintain and sustain the collaborative
partnerships.
e. A written narrative description of key personnel who will work on the
project and their qualifications for undertaking the project. You must also
submit resumes as an appendix (See item 6 below).
f. A description of managing federal funds* including information on all
adverse audit findings made within the last five years and special or "high
risk" terms and conditions imposed as a result of grant compliance issues
within the last five years and your history of providing required reports and
other project deliverables in a timely manner.
*Note: If you have not previously received Federal funds, you may provide a
history of your past performance with private funding, or funding awarded by
state, tribal or local governments. Applicants who have not performed projects
with outside financing may provide information regarding academic or community
projects.
(5) Environmental Results under Assistance Agreements template that
demonstrates how your project will further EPA's Strategic Plan for Healthy
Communities and Ecosystems using appropriate outputs and outcomes
(complete the template in Appendix D).
(6) An appendix with resumes of up to three key personnel who will be
significantly involved in the project (complete Key Contacts form in Appendix E).
(7) Documentation of nonprofit status which indicates the organization's 501 (c)(3)
nonprofit designation.
(8) Checklist for Determining Eligibility for CERCLA and Multi-Media Funding
to determine if your project can be funded under both programs. Please note
that even if an applicant qualifies under both programs, it can only be awarded
ONE grant if selected (complete the checklist in Appendix F).
(9) The Quality Assurance Project Plan Checklist, completed for all research
project applications (complete the checklist in Appendix G).
(10) A List which includes the title of the project and amount of funding provided by
EPA for any other grants or cooperative agreements from EPA in the last three
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years.
Applications that do not include aii applicable information listed above, will not
be considered for an award. Applications that propose projects that are ineligible
for funding or are not consistent with applicable environmental statutes (Section
III, C) will not be evaluated.
C. SUBMISSION DA TES AND TIMES
The full application package must be date stamped by courier service or
postmarked by the U.S. Postal Service by midnight, Monday, April 4, 2005. Use
the appropriate EPA regional office address listed in Section VII.
D. CONFIDENTIALITY AND INTERGOVERNMENTAL REVIEW
1. Confidentiality
In accordance with 40 CFR 2.203, applicants may claim all or a portion of their
application/proposal as confidential business information. EPA will evaluate
confidentiality claims in accordance with 40 CFR Part 2. Applicants must clearly mark
applications/proposals or portions of applications/proposals they claim as confidential.
If no claim of confidentiality is made, EPA is not required to make the inquiry to the
applicant otherwise required by 40 CFR 2.204(c)(2) prior to disclosure.
2. Intergovernmental Review
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 available at
http://www.whitehouse.aov/omb/arants/spoc.html.
E. 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 and be
allowable under OMB Circular A-122. 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 B). The scope of
environmental justice grants may not include construction, promotional items (e.g.,
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T-shirts, buttons, hats), and furniture purchases. Applicants may not receive
federal funding from more than one source for the same activities outlined in the
grant application workplan.
SECTION V - Application Review Information
A. EVALUATION CRITERIA
All applications will be reviewed and scored according to the following criteria:
1. Threshold Criteria
Proposals will not be scored if any of the following conditions exist:
(1) The applicant does not meet the qualifications of a local community-based
organization, Section III, A (regional offices may contact applicants to obtain
clarification);
(2) Application proposes a project that is inconsistent with the requirements for
eligible projects for this program, Section III, C (regional offices may not provide
an opportunity to provide clarification);
(3) The application does not include all items listed in Section IV, B.
2. Scoring Criteria
Applications meeting the threshold criteria will be scored by an EPA Review Panel,
consisting of regional staff. The corresponding points next to each criterion are the
weights EPA will use to score the applications. Points will range depending on how well
the applicant addresses the given criterion. Please note that certain sections are given
greater weight than others. The application will be scored based on the following
evaluation criteria:
(1) Complete work plan narrative addressing all of the below items (65 points).
The project work plan narrative is one of the most important components of your
application and (assuming that all other required materials are submitted) will be
the primary basis for selection. The work plan narrative must provide the
following information:
a. A one-page summary that identifies the following (5 points total):
1. Environmental and/or public health concern to be addressed by the
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project (2 points);
2. The community/target audience (1 point);
3. The program goal(s) that the project will meet and how it will meet it
(1 point); and
4. Applicable environmental statute(s) (CERCLA or statutes listed
under Section III, C, 1, b) (1 point). Please note that under certain
circumstances, the Region has the discretion to fund your project
under CERCLA or multi-media (See Appendix F for more
information).
b. A concise introduction (10 points total):
1. The nature of the organization: 1) how long it has been in existence
(1 point); and 2) how the applicant meets the definition of an
affected local community-based organization (1 point);
2. How the organization has been successful in the past on other
projects (2 points);
3. The type (CERCLA research or multi-media) and purpose of the
project (2 points);
4. Detailed characteristics of the affected community/target audience
(racial, ethnic and socioeconomic) (2 points); and
5. Project's completion plans/time-frames (2 point).
c. A concise project description (25 points total):
1. The details of the specific environmental and/or public health
issues to be addressed (10 points); and
2. An implementation plan describing in chronological order the
activities that will be undertaken (15 points).
d. A concise description of the collaborative partnership (25 points
total):
1. Describe how the collaborative partners will participate in the
18
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
project (5 points);
2. Explain the strategies for cooperation and communication with the
identified collaborative partners (5 points);
3. Describe the specific steps you have and/or will undertake to
engage in constructive engagement among collaborative partners
(5 points); and
4. Describe how you plan to maintain and sustain the collaborative
partnerships (10 points).
(2) A completed "Environmental Results Under Assistance Agreements"
template (15 points total) (See Appendix )
The activities under your project must demonstrate how they will further
EPA's Strategic Plan for Healthy Communities and Ecosystems using
appropriate outputs and outcomes.
(3) A written narrative of key personnel who will work on the project and their
qualifications for undertaking the project (5 points)
(Attention: The qualifications of the recipient's Project Manager is subject
to approval by the EPA Project Officer.)
(4) A detailed budget (10 points)
Must demonstrate how the funds will be specifically used in terms of
personnel, fringe benefits, travel, equipment, supplies, and other costs.
Funds cannot be used for construction, lobbying, or litigation against the
government.
(5) Describe your history of managing federal funds* generally (5 points total)
a. You must describe how you have effectively managed grants in the past.
If you have had adverse audit findings made within the last five years
and/or special or "high risk" terms and conditions imposed as a result of
grant compliance issues within the last five years please describe the
circumstances (2 points).
b. Describe your history of providing required reports and other project
deliverables in a timely manner (3 points).
19
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
*Note: If you have not previously received Federal funds, you may provide a history of
your past performance with private funding, or funding awarded by state, tribal or local
governments. Applicants who have not performed projects with outside financing may
provide information regarding academic or community projects.
B. REVIEW AND SELECTION PROCESS
The EPA regional offices will review, evaluate, and select grant recipients.
Applications will be screened to ensure that they meet all eligibility and threshold
requirements described in Sections III and IV. Applications which meet the threshold
requirements will be scored by regional review panels based on the evaluation criteria
outlined above. After the individual projects are scored, the EPA regional officials will
compare the best applications and make final recommendations.
Additional factors that the EPA will take into account include geographic and
socioeconomic balance, diverse nature of the projects and cost effectiveness. Regional
Administrators will select the final grants. Please note that this is a competitive grant
program and limited funding is available. Therefore, the Agency cannot fund all
applications. EPA reserves the right to reject all applications and make no awards
under this announcement. A listing of other EPA grant programs may be found in the
Catalog of Federal Domestic Assistance. This publication is available on the internet at
www.cfda.aov and at local libraries, colleges, and universities.
C. ANTICIPATED ANNOUNCEMENT AND A WARD DA TES
Feb. 18, 2005 FY 2005 Environmental Justice Small Grants Program
Application Guidance in English and Spanish is available on
www.fedarants.aov and
http://www.epa.aov/compliance/environmentaliustice/arants/
ej_smgrants.html . Hard copies are available upon request.
Feb. 18, 2005 to Eligible grant recipients develop and complete their
April 4, 2005 applications.
April 4, 2005 Application due to corresponding Regional Office listed in
Section VII which must be date stamped by courier
service or postmarked by the U.S. Postal Service by
midnight, Monday, April 4, 2005.
April 4, 2005 to EPA program officials review and evaluate
May 15, 2005 applications and select grant finalists
May 16, 2005 to Applicants will be contacted by the Region if their
June 30, 2005 applications are being considered for funding. Additional
information may be required from the finalists, as indicated
in Section VI, A. The EPA regional grants offices will
20
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
process grants and make awards.
August 1, 2005 EPA expects to announce the grant recipients of the FY
2005 Environmental Justice Small Grants Program.
SECTION VI - Award Administration Information
A. AWARD NOTICES
After all applications are received, acknowledgments will be mailed to applicants. 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 before receiving a grant, such as the EPA Form SF-424B (Assurances - Non-
Construction Programs) and EPA Form 5700-49, 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 designated EPA official or their
designees will notify those applicants whose projects are not selected for funding.
B. ADMINISTRA TIVE AND NA TIONAL POLICY REQUIREMENTS
All non-profit applicants are subject to 40 CFR Parts 30 "Uniform Administrative
Requirements for Grants and Agreements with Institutions of Higher Educations,
Hospitals, and other Non-Profit Organizations", OMB Circular A-122 "Cost Principles for
Non-profit Organizations", and OMB Circular A-133 "Audit Requirements for States,
Local Governments, and Non-Profit Organizations".
C. REPORTING
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 Semiannual Progress Reports, a Final Technical Report and a
Financial Status Report) will be described in the award agreement. The EPA will
collect, review, and disseminate grantees' final reports to serve as models. For further
information about this program, please visit OEJ's Web site at
http://www.epa.aov/compliance/environmentaliustice/arants/ei smgrants.html
21
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
D. DISPUTES
Assistance agreement competition-related disputes will be resolved in accordance with
the dispute resolution procedures published in 70 FR (Federal Register) 3629, 3630
(January 26, 2005) which can be found at:
http://a257.q.akamaitech. net/7/257/2422/01 ian20051800/edocket.access.qpo.qov/2005/05-1371 .htm
Copies of these procedures may also be requested by contacting the primary contact at
the respective EPA regional office listed in Section VII - Agency Contact(s).
E. QUALITY ASSURANCE PROJECT PLANS (QAPP)
A QAPP is a planning document for environmental data collection that describes the
necessary quality assurance and quality control activities that must be implemented to
ensure that the results of the study or investigation will be adequate to meet the
established performance criteria.
Environmental data can include any measurements or information that describe
environmental processes, location, or conditions; ecological or health effects and
consequences; or the performance of environmental technology. Environmental data
are defined as either primary data (i.e., information collected directly from
measurements) or secondary/existing data (i.e., data that were collected for other
purposes or obtained from other sources, including literature, surveys, models,
databases, and information systems).
Every research project will be reviewed to determine if a Quality Assurance Project Plan
(QAPP) will be required. If required, the QAPP must be submitted to your EPA Project
Officer prior to beginning of your research project that include scientific research and/or
data collection. To assist you in determining whether you need a QAPP for primary or
secondary data collection we have included a checklist in Appendix G. If you answer
yes to any of the questions, we have provided a template to assist you in preparing your
QAPP. The template is available on the OEJ Web site,
http://www.epa.aov/compliance/environmentaliustice/arants/index.html. For more
information and guidance on preparing Quality Assurance Project Plans visit the Web
sites http://www.epa.aov/aualitv/aapps.html and
http://www.epa.gOv/quality/exmural.html#graded.
22
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
SECTION VII - Agency Contact(s)
A. WHEN AND WHERE MUST APPLICA TIONS BE SUBMITTED?
The applicant must submit/mail one signed original application with required attachments and
one copy to the primary contact at the respective EPA regional office listed below. The
application must be date stamped by courier service or postmarked by the U.S. Postal
Service by midnight, Monday, April 4, 2005.
REGIONAL CONTACT NAMES AND ADDRESSES
Region I Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
Primary Contact: Davina Wysin (617) 918-1020
wvsin.davina@epa.gov
USEPA Region 1 (RAA)
One Congress Street - Suite 1100
Boston, MA 02203-0001
Secondary Contact: Sires Rivers (617)918-1343
rivers.sires@epa.gov
Region 2
Primary Contact:
Secondary:
New Jersey, New York, Puerto Rico, U.S. Virgin Islands
Terry Wesley (212) 637-5027
weslev.terrv@epa.gov
USEPA Region 2
290 Broadway, 26th Floor
New York, NY 10007
Tasha Frazier (212) 637-3861
frazier.tasha@epa.gov
Region 3 Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia
Primary Contact: Reginald Harris (215) 814-2988
harris.reggie@epa.gov
USEPA Region 3 (3DA00)
1650 Arch Street
Philadelphia, PA 19103-2029
Region 4 Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, Tennessee
Primary Contact: Elvie Barlow (404)562-9650
barlow.elvie@epa.gov
USEPA Region 4 Main Office (404) 562-8407
61 Forsyth Street
Atlanta, GA 30303-8960
Secondary: Ella Mclendon (404) 562- 8316
mclendon.ella@epa.gov
23
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Region 5
Primary Contact:
Secondary:
Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin
Margaret Millard (312) 353-1440
millard.margaret@epa.gov
USEPA Region 5 (DM7J)
77 West Jackson Boulevard
Chicago, IL 60604-3507
Alan Walts (312) 353-8894
walts.alan@epa.gov
Region 6
Primary Contact:
Secondary Contact:
Arkansas, Louisiana, New Mexico, Oklahoma, Texas
Shirley Quinones (214) 665-2713
quinones.shirlev@epa.gov
USEPA Region 6
Fountain Place, 13th Floor
1445 Ross Avenue (RA-D)
Dallas, Texas 75202-2733
Nelda Perez (214) 665-2209
perez.nelda@epa.gov
Region 7
Primary Contact:
Secondary
Iowa, Kansas, Missouri, Nebraska
Althea Moses (913) 551-7649
moses.althea@epa.gov
USEPA Region 7
901 North 5th Street (RGAD/ECO)
Kansas City, KS 66101
Monica Espinosa ( 913) 551-7058
espinosa.monica@epa.gov
Region 8
Primary Contact:
Secondary:
Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
Nancy Reish (303) 312-6040
reish.nancv@epa.gov
USEPA Region 8 (8ENF-EJ)
999 18th Street, Suite 300
Denver, CO 80202-2466
Jean Belille (303) 312-6556
belille.iean@epa.gov
Region 9
Primary Contact:
Secondary:
Arizona, California, Hawaii, Nevada, American Samoa, Guam
Romel Pascual (415) 972-3795
pascual.romel@epa.gov
USEPA Region 9 CMD-1
75 Hawthorne Street
San Francisco, CA 94105
Nate Lau (415) 972-3839
lau.nate@epa.gov
Region 10
Primary Contact:
Secondary:
Alaska, Idaho, Oregon, Washington
Susanne Salcido (206)-553-l687
salcido.susanne@epa.gov
USEPA Region 10 (OMP-143)
1200 Sixth Avenue
Seattle, WA 98101
Victoria Plata (206) 553-8580
Plata.victoria@epa.gov
24
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
SECTION VIII - Other Information
A. How Can I Receive Information on the Fiscal Year 2006 (October 1, 2005 to
September 30, 2006) Environmental Justice Small Grants Program?
If you wish to subscribe the EPA-EJ listserv go to
http://www.epa.aov/compliance/resources/listserv.html. select "Environmental Justice",
add your email address, name, select subscribe and submit. You will receive current
news as well as information on the FY 2006 Environmental Justice Small Grants
Program. You my also email your request along with your name, organization, address,
and phone number to lewis.sheila@epa.aov or mail your request along with your
name, organization, address, and phone number to:
U.S. Environmental Protection Agency
Environmental Justice Small Grants Program (2201A)
FY 2006 Grants Mailing List
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 above. Thank you for your interest in
the Environmental Justice Small Grants Program.
25
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
APPLICATION PACKAGE CHECKLIST
~ Application Form - SF 424, 424A including a budget worksheet
~ Budget Detail
~ Work plan narrative - Prepared according to instructions provided
~ Environmental Results under Assistance Agreements (Appendix D)
~ Resumes of key personnel ( Key Contact form - Appendix E)
~ Documentation of nonprofit status
~ Checklist for Determining Eligibility for CERCLA and Multi-
Media Funding (Appendix F)
~ Complete Quality Assurance Project Plan checklist, if applicable
(Appendix G)
26
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix A - Application Forms, Completed Sample Forms and Budget Detail
(Standard Forms 424 and 424A)
Application Packages are available on
http://www.epa.aov/compliance/environmentaliustice/arants/ei smgrants.html in Adobe
pdf format. To view the Adobe file, you will need the Adobe Acrobat plug-in for your
browser.
27
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Version 7/03
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED
2/17/05
Applicant Identifier
1. TYPE OF SUBMISSION:
Application
Pre-application
3. DATE RECEIVED BY STATE
State Application Identifier
1 1 Construction
X Non-Construction
1 1 Construction
l~l Non-Construction
4. DATE RECEIVED BY FEDERAL AGENCY
Federal Identifier
5. APPLICANT INFORMATION
Legal Name:
Organizational Unit:
ACME Non-profit
Department:
Organizational DUNS:
55-55555
Division:
Address:
Name and telephone number of person to be contacted on matters involving this
application (give area code)
Street:
1313 Mockingbird Lane
Prefix:
Mr.
First Name:
Charles
City:
Anywhere, USA
Middle Name:
Middle Name
County:
Anywhere
Last Name:
Brown
State:
OK
Zip Code:
11111
Suffix:
Country:
USA
Email:
Name.namefajhelpme. org
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
00-0000000
Phone Number (give area code)
xxx-xxx-xxxx
Fax Number (give area code)
xxx-xxx-xxxx
8. TYPE OF APPLICATION:
X New n Continuation D Revision
If Revision, enter appropriate letter(s) in box(es)
(See back of form for description of letters.)
7. TYPE OF APPLICANT: (See back of form for Application Types)
Only Category Eligible IS: 501(c)3 Local Community-Based Non-Profit
Other (specify)
Other (specify)
9. NAME OF FEDERAL AGENCY: US Environmental Protection Agency
10 CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
66.604
11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Include title and a paragraph describing your project.
TITLE (Name of Program): Environmental Justice Small Grants Program
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc):
13. PROPOSED PROJECT
14. CONGRESSIONAL DISTRICTS OF:
Start Date:
10/1/05
Ending Date:
9/30/06
a. Applicant
b. Project
15. ESTIMATED FUNDING:
$25,000
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. Federal
$ 25,000
a. Yes X THIS PREAPPLICATION/APPLICATION WAS MADE
b. Applicant
$ 0
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR
c. State
$ 0
REVIEW ON
d. Local
$ 0
DATE: 8/1/05
e. Other
$ 0
b. No U PROGRAM IS NOT COVERED BY E. O. 12372
~ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW
f. Program Income
$ 0
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g. TOTAL
$ 25,000
1_| Yes If "Yes" attach an explanation.
~ 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. Authorized Representative
Prefix
Mr.
First Name
Charles
Middle Name
Middle Name
Last Name
Brown
Suffix
b. Title
President
c. Telephone Number (give area code)
xxx-xxx-xxxx
d. Signature of Authorized Representative
e. Date Signed
NO LATER THAN 4/5/05
Standard Form 424 (Rev. 9-2003F-424 (Rev. 7-97)
-------
Version 7/03
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED
Applicant Identifier
1. TYPE OF SUBMISSION:
Application
l~l Construction
~ Non-Construction
Pre-application
l~l Construction
~ Non-Construction
3. DATE RECEIVED BY STATE
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY
Federal Identifier
5. APPLICANT INFORMATION
Legal Name:
Organizational Unit:
Department:
Organizational DUNS:
Division:
Address:
Name and telephone number of person to be contacted on matters involving this
application (give area code)
Street:
Prefix:
First Name:
City:
Middle Name:
County:
Last Name:
State:
Zip Code:
Suffix:
Country:
Email:
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
nn-nnnnnnn
Phone Number (give area code)
Fax Number (give area code)
8. TYPE OF APPLICATION:
~ New ~ Continuation ~ Revision
If Revision, enter appropriate letter(s) in box(es)
(See back of form for description of letters.)
Other (specify)
7. TYPE OF APPLICANT: (See back of form for Application Types)
Other (specify)
9. NAME OF FEDERAL AGENCY:
10 CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
nn-nnn
TITLE (Name of Program):
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc):
13. PROPOSED PROJECT
14. CONGRESSIONAL DISTRICTS OF:
Start Date:
Ending Date:
a. Applicant
b. Project
15. ESTIMATED FUNDING:
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. Federal
b. Applicant
. State
d. Local
e. Other
a. Yes ~ THIS PREAPPLICATION/APPLICATION WAS MADE
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR
REVIEW ON
DATE:
b. No ~ PROGRAM IS NOT COVERED BY E. O. 12372
~ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR
REVIEW
f. Program Income
$
g. TOTAL
$
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
~ Yes If "Yes" attach an explanation. ~ 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. Authorized Representative
Prefix
First Name
Middle Name
Last Name
Suffix
b. Title
c. Telephone Number (give area code)
d. Signature of Authorized Representative
e. Date Signed
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 424 (Rev. 9-2003)
Prescribed by OMB Circular A-102
-------
INSTRUCTIONS FOR Till 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: Entry:
Select Type of Submission.
Item:
11.
Entry:
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.
Date application submitted to Federal agency (or State if applicable)
and applicant's control number (if applicable)
12.
List only the largest political entities affected (e.g., State, counties,
cities).
State use only (if applicable).
13.
Enter the proposed start date and end date of the project.
Enter Date Received by Federal Agency Federal identifier number: If
this application is a continuation or revision to an existing award,
enter the present Federal Identifier number. If for a new project,
leave blank.
14.
List the applicant's Congressional District and any District(s)
affected by the program or project
Enter legal name of applicant, name of primary organizational unit
(including division, if applicable), which will undertake the assistance
activity, enter the organization's DUNS number (received from Dun
and Bradstreet), enter the complete address of the applicant (including
country), and name, telephone number, e-mail and fax of the person
to contact on matters related to this application.
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.
Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.
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.
Select the appropriate letter in
17.
the space provided.
I. State Controlled
A.
State
Institution of Higher
B.
County
Learning
C.
Municipal
J. Private University
D.
Township
K. Indian Tribe
E.
Interstate
L. Individual
F.
Intermunicipal
M. Profit Organization
G.
Special District
N. Other (Specify)
H.
Independent School
O. Not for Profit
District
Organization
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.
Select the type from the following list:
• "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. If a revision enter the
appropriate letter:
A. Increase Award B. Decrease Award
C. Increase Duration D. Decrease Duration
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.)
9.
"ToT
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.
SF-424 (Rev. 7-97) Back
-------
BUDGET INFORMATION - Non-Construction Programs
OMB Approval No. 0348-0044
SECTION A - BUDGET SUMMARY
Grant Program
Function
or Activity
(a)
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
(8)
TOTALS
SECTION B -BUDGET CATEGORIES
6. OBJECT CLASS CATEGORIES
GRANT PROGRAM, FUNCTION OR ACTIVITY
(1)
(2)
(3)
(4)
Total
(5)
a. Personnel
$11,800.00
$11,800.00
b. Fringe Benefits
2,006.00
2,006.00
c. Travel
1,480.00
1,480.00
d. Equipment
2,223.00
2,223.00
e. Supplies
2,200.00
2,200.00
f. Contractual
3,149.00
3,149.00
g. Construction
h. Other
2,142.00
2,142.00
i. Total Direct Charges (sum of 6a-h)
j. Indirect Charges
k. TOTALS (sum of 6i and 6j)
25,000.00
25,000.00
7. Program Income
0
Previous Edition Usable
Authorized for Local Reproduction
************* SAMPLE **************
Standard Form 424A (Rev. 7-97)
Prescribed by OMB Circular A-102
29
-------
M.f'l l<>\ ( - \o\-| I.DI.K \l K 1 sol KC 1 s
(a) Grant Program
(b) Applicant
(c) State
(d) Other Sources
(e) TOTALS
8. NONE
$ N/A
$ N/A
$ N/A
$ N/A
9.
10.
11.
12. TOTAL (sum of lines 8 and 11)
$
$
$
$
M (1 l<>\ 1) - 1 OKI ( \s | | |) ( \s|| \|.|.|)s
13. Federal
(Total for IstYear)
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
$ 25,000
$10,000
$5,000
$5,000
$5,000
14. Non-Federal
0
0.00
0.00
0.00
0.00
15. TOTAL (sum of lines 13 and 14)
$ 25,000
$ 10,000
$5,000
$5,000
$5,000
S| ( 1 ]u\ I - IU |)(,l. 1 I.M ]\1 \ 1 l.s ()| 1 1.1)1 K \ 1 1 I \I)S M.I. 1)1.1) 1 UK UAI.AM 1 <>l Mil. I'K< ).l I ("I
(a) Grant Program
FUTURE FUNDING PERIODS (Years)
(b) First
(c) Second
(d) Third
(e) Fourth
16.
$
$
$
$
17
18.
19.
20. TOTALS (sum of lines 16 - 19)
$
$
$
$
M.C'I M)\ 1 -<)'| IN K HI IHil 1 l\l UK\] VI ]<>\
21. Direct Charges:
22. Indirect Charges:
23. Remarks:
SF 424A (7-97) Page 2
AUTHORIZED FOR LOCAL REPRODUCTION
************* £ A A/I PI .F. **************
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OMB Approval No. 0348-0044
BUDGET INFORMATION - Non-Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program
Function
or Activity
(a)
Catalog of Federal
Domestic Assistance
Numb er
(b)
Estimated Unobligated Funds
New or Revised Budget
Federal
(c)
Non-Federal
(d)
Federal
(e)
Non-Federal
(f)
Total
(g)
1.
$
$
$
$
$ 0.00
2.
0.00
3.
0.00
4.
0.00
5. Totals
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
SECTION B - BUDGET CATEGORIES
6. Object Class Categories
GRANT PROGRAM, FUNCTION OR ACTIVITY
Total
(5)
(1)
(2)
(3)
(4)
a. Personnel
0.00
b. Fringe Benefits
0.00
c. Travel
0.00
d. Equipment
0.00
e. Supplies
0.00
f. Contractual
0.00
g. Construction
0.00
h. Other
0.00
i. Total Direct Charges (sum of 6a-6h)
0.00
0.00
0.00
0.00
0.00
j. Indirect Charges
0.00
k. TOTALS (sum of 6i and 6j)
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
7. Program Income
$
$
$
$
$ 0.00
Authorized for Local Reproduction Standard Form 424A (Rev. 7-97)
Previous Edition Usable Prescribed by OMB Circular A-102
-------
SECTION C - NON-FEDERAL RESOURCES
(a) Grant Program
(b) Applicant
(c) State
(d) Other Sources
(e) TOTALS
8.
$ 0.00
9.
$ 0.00
10.
$ 0.00
11.
$ 0.00
12. Total (SUM OF LINES 8-11)
$ 0.00
SECTION D - FORECASTED CASH NEEDS
13. Federal
Total for 1st Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
$ 0.00
$
$
$
$
14. Non-Federal
0.00
15. TOTAL (sum of lines 13 and 14)
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
FUTURE FUNDING PERIODS (years)
(b) First
(c) Second
(d) Third
(e) Fourth
16.
$
$
$
$
17.
18.
19.
20. TOTAL (sum of lines 16-19)
$ 0.00
$ 0.00
$ 0.00
$ 0.00
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges: 22. Indirect Charges:
23. Remarks:
Authorized for Local Reproduction
Standard Form 424A (Rev. 7-97) Page 2
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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 collection of
information. Send comment 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 COMPLETED FORM TO THE OFFICE OF MANAGEMENT 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 requires
Federal authorization in annual or other funding period
increments. In the latter case, Sections 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 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 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 Column (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.
Line 6a-i - Show the totals of Lines 6a 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
amount shown in Section A, Column (g), Line 6. For
supplemental grants and changes to grants, the total amount of the
increase or decrease as shown in Columns (l)-(4), Line 6k should
be the same as the sum of the amounts in Section A, Columns (e)
and (f) on Line 5.
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
SF-424A (Rev. 7-97) Page 3
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INSTRUCTIONS FOR THE SF-424A (continued)
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 contributions 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 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 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 (Rev. 7-97) Page 4
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
BUDGET DETAIL
ii.
Personnel
0.5 FTE Community Research Worker $10.00/hour
0.2 FTE Project Coordinator @ $12.00/hour
0.2 FTE Gtant administration $7.00/liour
Fringe Benefits at 17%
0.5 FTE Community Researcli Worker
0.2 FTE Project Coordinator
0.2 FTE Grant administration
$ 6,400.00
2,900.00
2.500.00
11,800.00
$1,088.00
493.00
425.00
2,006.00
III.
VI.
Travel
Local
IV.
Ea id
rent
Audi
o 1
Y^-t
TypJ
pit or
V.
Suvri
lie
VII. CoH|rS
XYZ Englfieenn
Total
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix B 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-Profit 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 2005
Appendix C 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.
33
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix C 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.
34
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix C 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.
35
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix D
ENVIRONMENTAL RESULTS UNDER ASSISTANCE AGREEMENTS
1
Link to EPA
Strategic Plan
2
Resources/
Input
3
Activities (and
targets, if any)
4
Stated Outputs
(with targets)
5
Anticipated
Outcomes
(with targets)
a. Long-term
b. Interim
c. Short-term
6
Baseline
Was baseline measure
established?
36
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix E KEY CONTACT FORM
Authorized Representative: Original awards and amendments will be sent to this individual for review and acceptance, unless
otherwise indicated.
Name:
Title:
Mailing Address:
Phone Number:
Payee: Individual authorized to accept payments
Name:
Title:
Mailing Address:
Phone Number:
Administrative Contact: Individual from Sponsored Program Office to contact concerning administrative matter (i.e., indirect
cost rate computation, rebudgeting requests, etc.)
Name:
Title:
Mailing Address:
Phone Number:
Principal Investigator: Individual responsible for the technical completion of the proposed work.
Name:
Title:
Mailing Address:
Phone Number:
37
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix F Checklist for Determining Eligibility for CERCLA and Multi-
Media Funding
Your project maybe considered under both CERCLA and multi-media funding if you can answer "Yes" to
ALL of the following questions. Each Region has the discretion to fund your project using either of the
funding sources (CERCLA or multi-media) if it is determined that your project can fit under both programs.
Please answer "Yes" or "No" to the following questions:
1. My project is a research project (See Section HI, C, 1, a for the definition of "research").
Yes ~ No ~
2. My project either (1) involves training on research techniques OR (2) does not carry out any training
activities at all.
Yes ~ No ~
3. My project relates to "hazardous substances" as that term is defined by CERCLA 101(14).
Yes ~ No ~
4. My project does NOT relate to contamination from petroleum products in accordance with the
definition of hazardous substances found at CERCLA 101(14).
Yes ~ No ~
5. My project either (1) does NOT include conferences OR (2) includes conferences but only for the
purpose of presenting research results or to gather research data.
Yes ~ No ~
6. My project meets the CERCLA research requirements AND involves two or more qualified statutes
listed under Section III, C, 1, b.
Yes ~ No ~
38
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Appendix G QUALITY assurance project plan checklist
The following types of information are typically gathered by grantees. Check Yes or No for each of the items
provided below as it applies to your specific grant proposal:
1. Grantee will collect groundwater, soil, sediment,
surface water, air, biota or fauna samples for chemical
chemical or biological analysis. Yes ~ No ~
2. Grantee will use existing computer databases
containing analytical data or personal information
previously collected. Yes ~ No ~
3. Grantee will use existing historical research
pertaining to this project or proposal. Yes ~ No ~
4. Grantee will implement deed searches
for current property or site. Yes ~ No ~
5. Grantee will conduct medical records search
for population covered in grant. Yes ~ No ~
6. Grantee will compile meteorological data
to determine weather trends or air
mixing trends. Yes ~ No ~
7. Grantee will use existing statistical studies or
will conduct these studies as part of the grant. Yes ~ No ~
8. Grantee will create a new database
based on the information gathered. Yes ~ No ~
9. Grantee will use this information for
litigation purposes. Yes ~ No ~
10. Your project will use this information to make
recommendations on environmental decisions Yes ~ No ~
If Yes has been entered for any of the items listed above, the grantee MUST submit a Quality Assurance Project
Plan in accordance with EPA Requirements for Quality Assurance Project Plans, EPA QA/R-5 (March 2001)
document to meet the EPA's grant conditions. This document can be accessed at www.epa.gov/quality. (The
grantee must select the "guidance" topic located to the left of the web page).
39
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Office of Environmental Justice Small Grants Program
Application Guidance FY 2005
Left Blank Intentionally
40
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