Attachments- HALEU Innovative Technology NOFO.pdf

Notice of Funding Opportunity: DE-FOA-0003487

High-Assay Low-Enriched Uranium (HALEU) Innovative Technology

DOE Provided Templates

Per NOFO Part 1, Application Content Requirement—Required Application Documents, the following templates, forms, and documents are being provided for the administrative convenience of the applicant as part of this funding opportunity package. See attached.

Any additional templates, forms, and documents stated as a requirement in NOFO Part 1, Application Content Requirement—Required Application Documents can be downloaded from various sites as indicated in each of their sections in NOFO Part 2.

It is the applicant's responsibility to ensure that all requirements for application submissions align with NOFO Part 1 & 2.

1. Application for Federal Assistance

2. Statement of Project Objectives

3. Project Management Plan

4. Research and Related Budget – Section A-B Form

5. Budget Justification – Applicant (same document to be used for prime and sub-recipients)

6. Current and Pending Support

7. Location(s) of Work

8. Disclosure of Lobbing Activities

9. Certification Regarding Lobbing

10. FFRDC-Field Work Proposal Budget

11. Summary for Public Release

OMB Number: 4040-0004 Expiration Date: 11/30/2025

Application for Federal Assistance SF-424

*1. Type of Submission:

Preapplication

Application

Changed/Corrected Application

*2. Type of Application

New

Continuation

Revision

* If Revision, select appropriate letter(s):

* Other (Specify)

*3. Date Received: 4. Applicant Identifier:

5a. Federal Entity Identifier: *5b. Federal Award Identifier:

State Use Only:

6. Date Received by State: 7. State Application Identifier:

8. APPLICANT INFORMATION:

*a. Legal Name:

*b. Employer/Taxpayer Identification Number (EIN/TIN): *c. UEI:

d. Address:

*Street 1:

Street 2:

*City:

County/Parish:

*State:

*Province:

*Country:

*Zip / Postal Code

e. Organizational Unit:

Department Name: Division Name:

f. Name and contact information of person to be contacted on matters involving this application:

Prefix: *First Name:

Middle Name:

*Last Name:

Suffix:

Title:

Organizational Affiliation:

*Telephone Number: Fax Number:

*Email:

*9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

*Other (Specify)

*10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

*12. Funding Opportunity Number:

*Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

*15. Descriptive Title of Applicant’s Project:

Attach supporting documents as specified in agency instructions.

16. Congressional Districts Of:

*a. Applicant: *b. Program/Project:

Attach an additional list of Program/Project Congressional Districts if needed.

17. Proposed Project:

*a. Start Date: *b. End Date:

18. Estimated Funding ($):

*a. Federal

*b. Applicant

*c. State

*d. Local

*e. Other *f. Program Income *g. TOTAL

*19. Is Application Subject to Review By State Under Executive Order 12372 Process?

a. This application was made available to the State under the Executive Order 12372 Process for review on

b. Program is subject to E.O. 12372 but has not been selected by the State for review.

c. Program is not covered by E.O. 12372.

*20. Is the Applicant Delinquent On Any Federal Debt?

Yes No

If “Yes”, explain:

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U. S. Code, Title 218, Section 1001)

** I AGREE

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representative:

Prefix: *First Name:

Middle Name:

*Last Name:

Suffix:

*Title:

*Telephone Number: Fax Number:

* Email:

*Signature of Authorized Representative: *Date Signed:

Federal Award Identifier:

Applicant Identifier Field:

Federal Entity Identifier Field:

FundingTite:

CDFAtitle: Airport Improvement Program

FundFedShare: 0

FundApplicant: 0

FundTotal: 0

FundState: 0

FundLocal: 0

FundOther: 0

FundPgmIncome: 0

SubmisisonType: Off

LegalName:

AppType: Off

TypeAppRevLetters:

AppTypeOther:

DateStateRcv:

StateAppnID:

EINTIN:

Street2:

City:

County:

State:

Province:

Country: USA: United States

ApplicantOther:

CatalogNum: 20.106

FedAgencyName: Federal Aviation Administration

FundOpportunityNum:

CompetitionIDNum:

CompetitionTitle:

AffectedAreas:

CongDistrictOfc:

CongDistrictApt:

DelinquentExplain:

AppnStateRvw: Off

AppnEO: Off

AppnNoEO: Off

StateAppnRvwDate:

AuthRepNamePrefix: [ ]

AuthRepNameSuffix: [ ]

AuthRepFirstName:

AuthRepMidName:

AuthRepLastName:

AuthRepTitle:

AuthRepPhoneNum:

AuthRepFaxNum:

AuthRepEmail:

AuthRepSignDate:

AppnDelinquent: New

CertAgree: Off

ZIPcode:

RcvDate:

ProjStartDate:

ProjEndDate:

DeptName:

DivName:

NamePrefix: [ ]

POCFirstName:

POCMiddleName:

POCLastName:

NameSuffix: [ ]

POCTitle:

POCOrgAffiliatn:

POCphone:

POCFAX:

POCEmail:

Street1:

TitleDescript:

ApplicantType1: [Pick an applicant type]

ApplicantType2: [Pick an applicant type]

ApplicantType3: [Pick an applicant type]

UEI - Unique Entity ID:

CURRENT AND PENDING (OTHER) SUPPORT COMMON FORM

November 1, 2023

The individual agrees to update this disclosure at the request of the Federal research funding agency prior to the award of support and at any subsequent time the agency determines appropriate during the term of the award. (Refer to the Federal research funding agency’s policy on updating award support).

Instructions for Submission of the Current and Pending (Other) Support Common Form

Current and pending (other) support information is used to assess the capacity or any conflicts of commitment that may impact the ability of the individual to carry out the research effort as proposed. The information also helps assess any potential scientific and budgetary overlap/duplication with the project being proposed.

This document provides instructions on submission of current and pending (other) support information for each individual identified as a senior/key person on a Federally funded research project.1

A separate submission must be provided for each proposal and active project, as well as in-kind contributions using the instructions and format specified below. Note that there is no page limitation for this section of the application, though some fields have character limitations for consistency and equity.

Consulting activities must be disclosed under the proposals and active projects section of the form when any of the following scenarios apply:

• The consulting activity will require the senior/key person to perform research as part of the consulting activity;

• The consulting activity does not involve performing research, but is related to the senior/key person’s research portfolio and may have the ability to impact funding, alter time or effort commitments, or otherwise impact scientific integrity; or

• The consulting entity has provided a contract that requires the senior/key person to conceal or withhold confidential financial or other ties between the senior/key person and the entity, irrespective of the duration of the engagement.

Consistent with NSPM-33, individuals are required to disclose contracts associated with participation in programs sponsored by foreign governments, instrumentalities, or entities, including foreign government-sponsored talent recruitment programs. Further, if individuals receive direct or indirect support that is funded by a foreign government-sponsored talent recruitment program, even where the support is provided through an intermediary and does not require membership in the foreign government-sponsored talent recruitment program, that support must be disclosed. Individuals must also report other foreign government sponsored or affiliated activities. In accordance with 42 USC § 19232, individuals are prohibited from being a party in a malign foreign talent recruitment program.

1In accordance with the NSPM-33 Implementation Guidance, senior/key persons typically do not include graduate students.

https://www.nsf.gov/bfa/dias/policy/researchprotection/nspm33definitions.pdf https://www.nsf.gov/bfa/dias/policy/researchprotection/nspm33definitions.pdf https://www.nsf.gov/bfa/dias/policy/researchprotection/nspm33definitions.pdf https://www.nsf.gov/bfa/dias/policy/researchprotection/nspm33definitions.pdf#page=2 https://www.nsf.gov/bfa/dias/policy/researchprotection/nspm33definitions.pdf#page=3

A table entitled, NSPM-33 Implementation Guidance Pre- and Post-award Disclosures Relating to the Biographical Sketch and Current and Pending (Other) Support2 has been created to provide helpful reference information regarding pre-award and post-award disclosures. The table includes the types of activities to be reported, where such activities must be reported in the application, as well as when updates are required in the application and award lifecycle. A final column identifies activities that are not required to be reported.

Individuals are reminded not to submit any personal information in the current and pending (other) support. This includes items such as: home address; home telephone, fax, or cell phone numbers; home e-mail address; driver’s license number; marital status; personal hobbies; and the like. Such personal information is not appropriate for the current and pending (other) support template and is not relevant to the merits of the proposal. The Federal research funding agency is not responsible or in any way liable for the release of such material.

The format for submission of the two types of support: (a) proposals and active projects; and (b) in-kind contributions is provided below.

* = required

Identifying Information

*Name: Enter the name of the senior/key person (Last Name, First Name, and Middle Name, including any applicable suffix).

Persistent Identifier (PID) of the Senior/Key Person: Enter the PID of the senior key person.

The PID is a unique, open digital identifier that distinguishes the individual from every other researcher with the same or a similar name.

*Position Title: Enter the current position title of the senior/key person.

Organization and Location

*Name: Enter the name of the primary organization of the senior/key person.

*Location: Enter the City, State/Province, and Country where the primary organization is located. If the State/Province is not applicable, enter N/A.

a. Proposals and Active Projects

In this section, disclose ALL proposals and active projects in accordance with the definition for current and pending (other) support.

2 This table supersedes in its entirety, Table 2a and Paragraph 7 of the Disclosure Requirements and Standardization Section of the NSPM-33 Implementation Guidance.

https://www.nsf.gov/bfa/dias/policy/nspm_disclosuretable/nspm33_disclosuretable_sept2022.pdf https://www.nsf.gov/bfa/dias/policy/nspm_disclosuretable/nspm33_disclosuretable_sept2022.pdf https://www.nsf.gov/bfa/dias/policy/nspm_disclosuretable/nspm33_disclosuretable_sept2022.pdf https://www.nsf.gov/bfa/dias/policy/nspm_disclosuretable/nspm33_disclosuretable_sept2022.pdf https://www.nsf.gov/bfa/dias/policy/nspm_disclosuretable/nspm33_disclosuretable_sept2022.pdf https://www.nsf.gov/bfa/dias/policy/nspm_disclosuretable/nspm33_disclosuretable_sept2022.pdf https://www.nsf.gov/bfa/dias/policy/researchprotection/nspm33definitions.pdf#page=2

*Proposals and Active Projects

*Title: Enter the title of each proposal/active project being reported.

*Status of Support: Select the appropriate status type as defined below:

• Current – all active projects, or projects with ongoing obligations, from whatever source irrespective of whether such support is provided through the proposing organization or is provided directly to the individual.

• Pending – any proposal that is being considered for funding from a potential funding organization (including this proposal) irrespective of whether such support is provided through the proposing organization or is provided directly to the individual.

Proposal/Active Project Award Number (if available): Enter the applicable proposal/active project award number for each proposal and/or active project, if available.

*Source of Support: Identify the entity for each proposal and/or active project that is providing the support. Include all Federal, State, Tribal, territorial, local, foreign, public or private foundations, non-profit organizations, industrial or other commercial organizations, or internal funds allocated toward specific projects.

*Primary Place of Performance: Identify the primary location where the proposal and/or active project is being executed. Enter the City, State/Province, and Country where the organization is located. If the State/Province is not applicable, enter N/A.

*Proposal/Active Project Start Date: Indicate the start date (MM/YYYY) of the project, as proposed/awarded.

*Proposal/Active Project End Date: Indicate the end date (MM/YYYY) of the project, as proposed/awarded.

*Total Anticipated Proposal/Project Amount: Enter the total award amount for the entire period of performance, inclusive of indirect costs, rounded to the nearest dollar. If the dollar value is not readily ascertainable, a reasonable estimate should be provided. If the support is in a foreign country’s currency, convert to US dollars at time of submission.

*Person-Month(s) (or Partial Person-Months) Per Year Devoted to the Proposal/Active Project: Enter how much time the individual anticipates is necessary to complete the scope of work on the proposal and/or active project. Enter the number of person-months (even if unsalaried) for the current budget period and enter the proposed person-months for each subsequent budget period. If the time commitment is not readily ascertainable, a reasonable estimate should be provided.

*Overall Objectives: Provide a brief statement of the overall objectives of the proposal/active project. This field is limited to 1500 characters.

*Statement of Potential Overlap: Enter a description of the potential overlap with any pending proposal or active foreign or domestic project and this proposal in terms of scope, budget, or person-months planned or devoted to the project by the individual. If there is no potential overlap, enter “none” in this field.

b. In-Kind Contributions

In this section, disclose all in-kind contributions with an estimated dollar value of $5000 or more and that require a commitment of the individual’s time. An in-kind contribution is a non-cash contribution provided by an external entity that directly supports the individuals’ research and development efforts. An in-kind contribution may include but is not limited to: real property;

laboratory space; equipment; data or data sets; supplies; other expendable property; goods and services; employee or student resources. In-kind contributions with an estimated value of less than $5000 need not be reported.

*Status of Support: Select the appropriate status type as defined below:

• Current – all in-kind contributions obligated from whatever source irrespective of whether such support is provided through the proposing organization or is provided directly to the individual.

• Pending – all in-kind contributions currently under consideration from potential funding organizations irrespective of whether such support is provided through the proposing organization or is provided directly to the individual.

*Receipt (or Anticipated Receipt) Date of In-Kind Contribution: Enter the receipt date (or anticipated receipt date) of the in-kind contribution.

*Source of Support: Identify the entity (entities) that is providing the in-kind contribution.

Include, for example, Federal, State, Tribal, territorial, local, foreign, public or private foundations, non-profit organizations, industrial or other commercial organizations, or internal funds allocated toward specific projects.

*Summary of In-Kind Contribution(s): Enter a summary of the in-kind contribution not intended for use on the proposal/active project.

*Person-Month(s) (or Partial Person-Months) Per Year Devoted to the In-Kind Contribution: Enter how much time the individual anticipates is necessary to complete the scope of work associated with use of the in-kind contribution. Enter the number of person-months (even if unsalaried) for the current budget period and enter the proposed person-months for each subsequent budget period. If there is no associated time commitment, the in-kind contribution need not be reported.

*US Dollar Value of In-Kind Contribution: Enter the US dollar value of the in-kind contribution with an estimated value of $5000 or more. If the dollar value is not readily ascertainable, a reasonable estimate should be provided. If the support is in a foreign country’s currency, convert to US dollars at time of submission, rounded to the nearest dollar.

*Overall Objectives: Provide a brief statement of the overall objectives of the in-kind contribution(s). This field is limited to 1500 characters.

*Statement of Potential Overlap: Enter a description of the potential overlap with any current or pending foreign or domestic in-kind contribution and this proposal in terms of scope, budget, or person-months planned or devoted to the project by the individual. If there is no overlap, enter “none” in the field.

*Certification

Each senior/key person is required to complete the following certifications regarding the information provided in their Current and Pending (Other) Support:

I certify that the information provided is current, accurate, and complete. This includes, but is not limited to, information related to current, pending, and other support (both foreign and domestic) as defined in 42 U.S.C. §6605.

I also certify that, at the time of submission, I am not a party in a malign foreign talent recruitment program.

Misrepresentations and/or omissions may be subject to prosecution and liability pursuant to, but not limited to, 18 U.S.C. §§287, 1001, 1031 and 31 U.S.C. §§3729-3733 and 3802.

Signature3:

Date:

Note: A Privacy Act and Burden Statement must appear on the Current and Pending (Other) Support Common Form. Each Federal research funding agency that elects to use these forms must replace the following language and incorporate their specific System of Records Notice in their PRA common forms request submitted to OMB/OIRA for clearance.

*Privacy Act and Burden Statement:

The information requested on this form is solicited under the authority of the National Science Foundation Act of 1950, as amended. The information on this form will be used in connection with the selection of qualified proposals. The information requested may be disclosed to qualified reviewers and staff assistants as part of the proposal review process; to proposer institutions/grantees to provide or obtain data regarding the proposal review process, award decisions, or the administration of awards; to government contractors, experts, volunteers and researchers and educators as necessary to complete assigned work; to other government agencies or other entities needing information regarding Proposers or nominees as part of a joint application review process, or in order to coordinate programs or policy; and to another Federal agency, court, or party in a court or Federal administrative proceeding if the government is a party. Information about Principal Investigators may be added to the Reviewer file and used to select potential candidates to serve as peer reviewers or advisory committee members. See Systems of Records, NSF-50, "Principal Investigator/Proposal File and Associated Records,” 79 Federal Register 76398 (December 22, 2014), and NSF-51, "Reviewer/Proposal File and Associated Records," 79 Federal Register 76398 (December 22, 2014). Submission of the

3 To be acceptable to the Federal research funding agency, the date of the signature must be within the past 12 months from when the document is submitted to the federal research funding agency.

information is voluntary. Failure to provide full and complete information, however, may reduce the possibility of receiving an award.

An agency may not conduct or sponsor, and a person is not required to respond to, an information collection unless it displays a valid OMB control number. The OMB control number for this collection is 3145-0279. Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions. Send comments regarding the burden estimate and any other aspect of this collection of information, including suggestions for reducing this burden, to:

Reports Clearance Officer Policy Office, Division of Institution and Award Support Office of Budget, Finance, and Award Management National Science Foundation Alexandria, VA 22314

Location(s) of Work

Location(s) of Work yes

Recipient Name: Agreement # (CID):

Reporting Period Start Date: Reporting Period End Date:

Instructions:

Fill out the header information above with your Recipient Name & Agreement # (CID) and the current Reporting Period's Start and End Dates.

The Location(s) of Work report is required to be validated on a quarterly basis. This document will be used to identify each known location being served directly as a project work site location or a location impacted by the project. This includes the location(s) of construction or alteration activity and/or communities that may be a part of the proposed project's supply or waste life cycle (e.g., where raw materials come from, where waste is being sent).

If the recipient is an EECBG Grantee, Please select "yes" from the dropdown:

1. Column B: Identify the Location Type ( a project work or operations site or a community that is part of the project's supply or waste life cycle).

2. Column E: Input Subrecipient (if the location site was identified as a subrecipient location, indicate the subrecipient's name) or Community Name (If the location is an impacted location, identify the name of the impacted community).

3. For all other Columns: Select from the dropdown or input the requested information for each location identified.

Note: If you need additional rows, be sure to 'Copy' existing rows and 'Insert Copied Cells' for the drop-downs and conditional formatting to function properly.

Template Version: 3

Location(s) of Work

ZIP Code™ Lookup Latitude & Longitude Finder Climate and Economic Justice Screening Tool

Location Type Is this a Principal Place of Performance? Prime or Subrecipient Location? Subrecipient/Community Name Facility Name (if applicable) Briefly describe the primary activity at this location or with this population. For example, management headquarters; construction, operations, production; raw materials extraction, waste disposal, etc. Is location in a foreign country? Street Address City State 5-Digit Zip Code + 4

DS22: For assistance determining Zip Code use the USPS e-link in the header.

Latitude

Jacobi, Jennifer: For assistance in determining latitude and longitude, go to Google maps, right click on your location and lat and long will display. Or use the Latitude/Longitude Finder e-link in the header.

Please truncate latitude and longitude in excess of 6 digits after the decimal point. Longitude Does the location or community qualify as a disadvantaged community (DAC) according to the Climate and Economic Justice Screening Tool (CEJST)?

DS22: For help determining DAC qualification use the CEJST e-link in the header. If DAC, add the census tract number or describe the distributed disadvantaged community served (e.g. migrant workers):

DS22: Census Tract data will show in the column to the right of the map using the CEJST e-link in the header.

DS22: For assistance determining Zip Code use the USPS e-link in the header.

Jacobi, Jennifer: For assistance in determining latitude and longitude, go to Google maps, right click on your location and lat and long will display. Or use the Latitude/Longitude Finder e-link in the header.

Please truncate latitude and longitude in excess of 6 digits after the decimal point.

DS22: For help determining DAC qualification use the CEJST e-link in the header. Is construction signage installed at this location? Enter the % of work performed at this location

End of Table

Do not submit Protected Personally Identifiable Information (Protected PII) to DOE. For more information on Protected PII, see Appendix A of the BIL Federal Assistance Reporting Checklist.

https://tools.usps.com/zip-code-lookup.htm?byaddresshttps://screeningtool.geoplatform.gov/https://www.latlong.net/

Source

Location Type Category State

Project Work Site AL

Impacted Community: Project Supply AK

Impacted Community: Waste Cycle AZ

AR

AS

CA

Principal Place of Performance CO

Yes CT

No DE

FL

Prime or Subrecipient Location FM

Prime Recipient GA

Subrecipient GU

HI

Is location in a foreign country ID

Yes IL

No IN

IA

KS

Grantee KY

0 LA

ME

MD

MA

MH

MI

MN

MS

MO

MP

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PA

PR

PW

RI

SC

SD

TN

TX

UM

UT

VT

VA

VI

WA

WV

WI

WY

U.S. Department of Energy ORDER

Washington, D.C. DOE O 412.1A

Approved: 4-21-05

Admin Chg 1: 5-21-14

SUBJECT: WORK AUTHORIZATION SYSTEM

1. OBJECTIVES. To establish a work authorization and control process for work performed by designated site and facility management contractors, and other contractors as determined by the procurement executive, consistent with the budget execution and program evaluation requirements of the Department of Energy’s (DOE’s) Planning, Programming, Budgeting, and Evaluation process.

2. CANCELLATIONS. DOE O 412.1 Work Authorization System, dated 4-20-99.

Cancellation of a directive does not, by itself, modify or otherwise affect any contractual obligation to comply with such a directive. Cancelled directives that are incorporated by reference in a contract remain in effect until the contract is modified to delete the references to the requirements in the cancelled directives.

3. APPLICABILITY.

a. Primary DOE Organizations, Including National Nuclear Security Administration

(NNSA) Organizations. Except for the exclusions in paragraph 3c, this Order applies to all Primary DOE Organizations that direct work to be performed by site and facility management contractors and other contractors determined by the procurement executive. (See current listing at https://www.directives.doe.gov/references/DepartmentalElements).

The Administrator of NNSA shall assure that NNSA employees and contractors comply with their respective responsibilities under this Order.

b. Site/Facility Management Contractors. This Order will be applicable to contractors by provisions within the Department of Energy Acquisition

Regulation (DEAR).

c. Exclusions.

(1) Facilities and activities of the NNSA Office of Naval Reactors and

Bonneville Power Administration are excluded from the requirements of this Order.

(2) Work involving reimbursable work for others and services, products, or materials regularly produced for sale at scheduled rates under DOE programs (e.g., routine irradiation services, radioisotopes, production or transmission of electricity) are excluded from the requirements of this

Order.

AVAILABLE ONLINE AT: INITIATED BY:

http://www.directives.doe.gov Office of Acquisition and Project Management http://www.directives.doe.gov/ https://www.directives.doe.gov/references/DepartmentalElements

2 DOE O 412.1A

4-21-05

4. REQUIREMENTS.

a. Authorizations and deauthorizations for all DOE funded work must be documented in work authorizations. [Paperless generation and electronic transfer are preferred (see Attachment 2 for sample format).]

(1) A program office may request a contractor to use a suggested standard work proposal (Attachment 3) to provide information for program planning, budget formulation, or documentation of part or all of a work assignment.

(2) A site and facility management contractor may use a work proposal to propose work to a program office (see Attachment 3 for sample format).

b. At a minimum, each work authorization will contain the following information:

(1) project title and reference to work proposal number, if applicable;

(2) Headquarters programmatic point of contact, organization, and telephone number;

(3) Headquarters budget point of contact, organization code, and telephone

(4) responsible program;

(5) responsible program Secretarial Officer;

(6) responsible field organization;

(7) responsible contracting officer if different from 4b(6) above;

(8) site/facility management contractor name, point of contact, and telephone

(9) work authorization number (see paragraph 4c below), with revision number if applicable;

(10) budget and reporting code and funding level;

(11) dates for performance period, work start, and work completion;

(12) statement of work (see paragraph 4d below);

(13) reporting requirements, including (a) project management or status reports and (b) reports or publications for the purpose of informing DOE, the

3 DOE O 412.1A

scientific community, and the public of the project results (e.g., scientific advances or technical progress); and

(14) Headquarters, field organization, contractor, and if involving changes to scope, schedule, or funding, contracting officer signature blocks.

c. Each work authorization must have a unique, standardized identification number, which must remain unchanged for the total life of the work assignment.

d. The statement of work will include the following information as appropriate:

(1) detailed statement of work to be performed or reference to a work proposal, project plan, or similar document describing the scope of work in detail;

(2) required milestone dates;

(3) deliverables, including technical information as required by DOE

O 241.1B, Scientific and Technical Information Management, dated 12-

13-10; and

(4) associated performance-based indicators/targets consistent with DOE

G 120.1-5, Guidelines for Performance Measurement, dated 6-30-96, and any additional guidance that will assist the contractor in the performance of the work.

e. DOE field organizations (contracting officers) must receive a work authorization signed by the appropriate Primary DOE Organization, who must review and approve the work as acceptable for the contractor before obligating funds for the contract.

(1) Program offices may delegate some of the program managers’ responsibilities and authorities to DOE field organizations (e.g., assignment of tasks and/or distribution of funds to contractors under their cognizance).

(2) When responsibilities have been delegated, the field organization is responsible for preparing and issuing the work authorization.

f. A signed copy of each work authorization accepted by the contractor must be forwarded to DOE (preferably electronically) as evidence of acceptance of the authorized work.

(1) If the authorization does not change scope, schedule, or cost (e.g., incremental funding), then contractor signatures are not necessary. (Note, however, that if any changes are made, this information should still be forwarded to DOE as noted above.)

4 DOE O 412.1A

(2) Work is not authorized to commence until the contractor receives both funding (via a signed contract modification) and the related work authorization.

g. Funding guidance necessary to support work authorizations will be provided through the existing approved funding program (AFP) process.

(1) The contractor retains the flexibility to manage individual tasks within the work assignment.

(2) Manpower and dollars may be shifted, as necessary, subject to

Government imposed constraints and program office direction.

h. Authorizations for work planned in the current fiscal year are to be issued by the beginning of the fiscal year to the maximum extent possible.

(1) Work authorizations should be transmitted to the field promptly following the issuance of the advice of allotment by the Office of Management, Budget and Evaluation.

(2) Paperless generation and electronic transfer are preferred.

5. RESPONSIBILITIES.

a. Under Secretaries. Establish DOE policy for assignment and control of work authorization for designated site and facility management contractors.

b. Primary DOE Organizations.

(1) Inform other DOE organizations of restrictions or constraints on the use of facilities under their cognizance.

(2) Recommend to the cognizant Under Secretary appropriate changes in the policies for work authorization for designated site and facility management contractors.

c. Program Secretarial Officers.

(1) Provide general approval of work to be accomplished under the provisions of this Order, normally as part of institutional planning, budget formulation or execution, or similar processes. (Approval of specific work authorizations and associated documentation may be delegated.)

(2) Prepare work authorizations in accordance with paragraph 4, aggregating related work assignments at the highest appropriate level.

5 DOE O 412.1A

(3) To the maximum extent possible, issue full annual funding and associated work authorizations to site and facility management contractors as early in the fiscal year as possible.

(4) Ensure work to be assigned by work authorization—

(a) is appropriate for performance by a contractor;

(b) has clearly articulated requirements and technically and programmatically adequate documentation; and

(c) will be performed in a manner compliant with the terms and conditions of the contract, including security and environmental, safety, and health (ES&H) requirements.

(5) As needed, revise and issue work authorizations to DOE field organizations and request necessary AFP changes through the Chief

Financial Officer in accordance with established procedures for administrative control of funds.

(6) Transmit work authorizations to the field promptly with submission of the

AFP to the Chief Financial Officer.

(7) Ensure that formal agreement is reached with DOE field organizations anytime they are delegated technical assessment or technical oversight and control of work assignments.

(8) Monitor performance and reports submitted by contractors, unless this function is delegated, to ensure contractors comply with all work requirements defined in their contracts, including the statement of work, reporting requirements, documentation, data, cost management, work products, milestone schedules and deliverables.

d. DOE Field Organizations.

(1) Ensure work to be assigned by work authorization—

(a) is within the contracting officer’s representative’s (COR’s) delegated authority and

(b) is not duplicative of other ongoing work under the contractor’s responsibility.

(2) Ensure work performed by contractors does not violate constraints on use of DOE-controlled facilities and is carried out in a manner that protects the workers, the public, and the environment against ES&H hazards and safeguards and security risks arising from the performance of contract work.

6 DOE O 412.1A

(3) Ensure work authorization requirements have been satisfied before authorization to proceed and that the contractor has a clear understanding of what is required by the sponsoring program office before work commences.

(4) Review all work authorizations under their cognizance to ensure they are appropriate for performance; within mission; and for institutional plans as applicable, within scope and agreed to general levels of effort.

(5) Issue and revise work authorizations for assigned work if the assignment decision has been delegated.

(6) Ensure the contractor provides a signed copy of the work authorization and all required reports to Program Secretarial Officers as required.

(7) Monitor performance and reports submitted by contractors to ensure that work performed and costs incurred conform to work authorizations issued.

(8) Authorize work in accordance with the AFP, programmatic guidance, contract-specific COR appointment letters, and established procedures for administrative control of funds.

(9) Ensure costs related to work authorizations can be adequately tracked before issuing authorizations.

(10) Review work proposals prepared by contractors for consistency with program and other guidance.

(11) Transmit work proposals, with any comments and recommendations, to program offices in accordance with program guidance and budget time frames issued by the Chief Financial Officer.

(12) Ensure contractors provide technical information to the Director of

Scientific and Technical Information in accordance with reference 7e below.

(13) Perform contract oversight activities in accordance with the contract-specific COR appointment letter.

e. Office of the Chief Financial Officer. Performs tasks of an accounting and budgetary nature associated with the process described in this Order such as issuing allotments, AFPs, and financial reports.

7 DOE O 412.1A

6. REFERENCES.

a. Title XXXII of P.L. 106-65, National Nuclear Security Administration Act, dated

October 5, 1999, as amended.

b. DOE G 120.1-5, Guidelines for Performance Measurement, dated 6-30-96, provides guidance on performance measurement in DOE.

c. DOE O 130.1, Budget Formulation, dated 9-29-95, establishes policy provisions and defines roles and responsibilities of Departmental organizations and contractors participating in the Department’s annual budget formulation process.

d. DOE O 135.1A, Budget Execution Funds Distribution and Control , dated 1-9-06, describes DOE systems, policies, and assignment of requirements for control of the budget execution process

e. DOE O 241.1B, Scientific and Technical Information Management, dated 12-13-

10, provides guidance concerning the reporting and dissemination of technical information. Scientific and technical information resulting from work funded by

DOE is to be made broadly available to the scientific community and the public, within appropriate adherence to statutorily mandated protections.

f. DOE P 450.4A, Integrated Safety Management Policy, dated 4-25-11, provides for a formal process to plan, perform, assess, and improve the safe conduct of work.

g. DOE P 226.1B, Department of Energy Oversight Policy, dated 4-25-11, provides policy for DOE line management oversight of ES&H.

h. DOE O 452.1D, Nuclear Explosive and Weapon Surety Program, dated 4-14-09, establishes requirements and responsibilities for the DOE Nuclear Explosive and

Weapon Surety Program to ensure adequate safety, security, and control of nuclear explosives and nuclear weapons.

i. DOE O 452.2D, Nuclear Explosive Safety, dated 7-10-13, establishes requirements and responsibilities for ensuring the safety of both routine and planned DOE nuclear explosive operations and associated activities and facilities.

j. DOE O 452.4A, Security and Control of Nuclear Explosives and Nuclear

Weapons, dated 12-17-01, establishes DOE, including NNSA, requirements and responsibilities to prevent the deliberate unauthorized use of U.S. nuclear explosives and U.S. nuclear weapons.

k. NNSA Policy Letter NAP-24, Weapon Quality Policy, dated 6-20-13.

8 DOE O 412.1A

l. DOE O 414.1D Admin Chg 1, Quality Assurance, dated Apr 25, 2011.

m. DOE O 470.4B Admin Chg 1, Safeguards and Security Program, dated 7-

21-11, provides requirements and responsibilities for the appropriate protection levels against unauthorized access; theft, diversion, loss of custody, or destruction of nuclear weapons or components; espionage;

loss or theft of classified matter or Government property; and other hostile acts that impact national security, the health and safety of employees, the public, or the environment.

n. DOE O 534.1B, Accounting, dated 1-6-03, establishes requirements for financial management of cash, advances, receivables, inventories, and investment of funds;

accountability for plant and capital equipment; current and long-term liabilities;

and accounting for equity revenues, collections, expenses, and reimbursable work performed by DOE on behalf of Federal and non-Federal entities.

7. CONTACT. For assistance, contact the Office of Acquisition and Project

Management, 202-287-1310.

SAMUEL W. BODMAN

Secretary of Energy

DOE O 412.1A Attachment 1

SAMPLE WORK AUTHORIZATION

U.S. DEPARTMENT OF ENERGY

CONTRACT WORK AUTHORIZATION

1a. Project Title: 1b. Work Proposal Number (if applicable):

2. Headquarters Program Point of Contact.

Name: Organization Code: Telephone No.:

3. Headquarters Budget Point of Contact.

Name: Organization Code: Telephone No.:

4. Responsible Program: 5. Responsible Secretarial Officer:

6. Responsible Field Organization:

7a. Site and Facility Management Contractor:

10. Funds Authorized ($ in thousands).

7b. Contractor Point of Contact.

Name: Telephone No.:

8. Work Authorization Number: 9. Revision Number:*

Budget and Reporting Code: Previous: Change: Current:

11. Performance Period Covered by Funds. 12. Work Start Date: 13. Expected Completion Date:

From: To:

14. Statement of Work:

(Attach a detailed description of work to be performed or reference to a work proposal, project plan, or similar document that describes the scope of work, milestones, deliverables, performance measures/expectations.)

15. Reporting Requirements (Status reports, scientific and technical information or similar):

16. Work Authorization Program Official.

Name : Signature: Date:

17. DOE Field Organization Official.

Name (typed): Signature: Date:

18. Contractor’s Authorized Representative.

19. DOE Contracting Officer (or delegated representative).

*The revision number will consist of a 2-digit program identifier, 4-digit sequential number, and the last digit of the fiscal year.

DOE O 412.1A Attachment 2

SAMPLE WORK PROPOSAL

U.S. DEPARTMENT OF ENERGY

WORK PROPOSAL

1. Work Proposal Number: 2. Revision Number: 3. Date Prepared:

4. Work Proposal Title: 5. STARS Accounting Flexfield string (as available):

6. Work Proposal Term: Begin End

9. DOE Field Organization Work Proposal 10. DOE Field Organization:

Reviewer:

7. Name (Last, First, MI) and Phone Number 8. Headquarters Organization:

of the Headquarters Program Manager:

11. Contractor Work Proposal Manager: 12. Contractor Name:

13. Proposal Description (Approach, anticipated benefits in 200 words or less):

14. Contractor Work Proposal Manager: 15. DOE Field Organization Official:

(Signature) (Date) (Signature) (Date)

16. Detail Attachments: (See Specific Attachments)

a. Facility Requirements g. Future Accomplishments m. ES&H Considerations

b. Publications h. Relationships to Other Projects n. Human/Animal Subjects

c. Purpose (mandatory) i. NEPA Requirements o. Security Requirements

d. Background j. Milestones p. Other (specify)

e. Approach k. Deliverables

f. Technical Progress l. Performance Measures/ Expectations

WORK PROPOSAL REQUIREMENTS FOR OPERATING/EQUIPMENT

OBLIGATIONS AND COSTS

CONTRACTOR NAME: WORK PROPOSAL

NO.:

REV. NO.: DATE PREPARED:

Prior Years BY -1 Budget Year (BY) BY +1 BY +2

Total to Complete

17. Staffing (staff years):

a. Scientific

b. Other Direct

c. Total Direct.

Request

Authorized

18. Operating Expense:

a. Total Obligations

b. Total Costs

19. Equipment:

a. Equipment Obligations

b. Equipment Costs

20. Milestone Schedule: Proposed Authorized

21. Reporting Requirements (Description):

DOE WORK PROPOSAL INSTRUCTIONS

A. Pages 1 and 2 of the Work Proposal are optional but may be required by a program office for planning and budget formulation. It may be used as all or part of the documentation of a Work Authorization. The form may also be used by a site and facility management contractor to describe prospective work. The form is intended to provide an overview of the effort, including each of the tasks necessary for project completion. Proposals should be limited to a single project to allow reporting of costs, obligations, and other information.

B. Page 1 of the form.

Item 1. Enter a unique number for the proposal.

The first two characters of this number are to signify the DOE organizational code used when assigning regular contract numbers. The third character is to be the letter “W.” The remaining four characters will be a unique sequential number assigned by the requesting organization.

Item 2. If the initial proposal is changed, a revision is indicated by placing a number in this space, starting with the number “1” and proceeding in sequence.

Item 3. The month, day, and year the form is prepared (e.g., 10/01/03).

Item 4. A descriptive title of the work being proposed.

Item 5. The STARS Accounting Flexfield

(AFF) string in accordance with the AFF values and the B&R Classification Codes set forth on the Chief Financial Officer iPortal website athttps://iportalwc.doe.gov/webcenter/content/co nn/iPortalContent/path/MyWebCenterSpaces/EF

ASC1/BARC/index.htm.

Item 6. The start and estimated completion dates of the proposal. Use a two-number format for month, day, and year (e.g., 10/01/03). For proposals initiated for an indefinite period of time, the completion date should be shown as

“OPEN.”

Item 7. When known, enter the name and phone number of the DOE/NNSA program manager responsible for the overall program.

Item 8. The DOE/NNSA Headquarters office responsible for the overall program.

Item 9. When known, enter the name and phone number of the DOE field organization individual responsible for reviewing the proposal.

Item 10. The DOE field organization responsible for the work proposal.

Item 11. When known, enter the name and phone number of the contractor individual responsible for the proposal.

Item 12. Enter the name of the contractor responsible for the proposal.

Item 13. A description of the proposal, in

200 words or less, highlighting the purpose, approach, and anticipated benefits the proposal will provide in the program’s mission.

Item 14. The signature of the contractor representative responsible for the proposal and the date are to be entered when the proposal is given to the reviewing official.

Item 15. The signature of the reviewing official and the date are to be entered when the proposal is forwarded to the program manager.

https://iportalwc.doe.gov/webcenter/content/conn/iPortalContent/path/MyWebCenterSpaces/EFASC1/BARC/index.htm https://iportalwc.doe.gov/webcenter/content/conn/iPortalContent/path/MyWebCenterSpaces/EFASC1/BARC/index.htm https://iportalwc.doe.gov/webcenter/content/conn/iPortalContent/path/MyWebCenterSpaces/EFASC1/BARC/index.htm

DOE WORK PROPOSAL INSTRUCTIONS CONTINUED

Item 16. Detailed attachments are to be completed if they are necessary to understand or will enhance the proposal. Any attachments accompanying the proposal should be indicated by checking the appropriate blocks. Each attachment page should include the contractor name, the proposal number, and the date prepared.

a. Facility Requirements. If execution of the proposal requires the use of existing or approved facilities, briefly describe the required use and location, with associated gross square footage and impact on site utility services by fiscal year in which the proposal begins and each subsequent fiscal year during the anticipated life of the proposal. Facility needs will be reviewed in context of overall site planning and utilization and expressed in terms of space function (e.g., office, storage space, site utilities)

b. Publications. List all publications pertaining to the proposal during the prior fiscal year.

Provide the title or subject and planned date of publications of all topical reports over the life of the proposal. Periodic progress reports are to be listed in this section.

c. Purpose. Provide the reasons for the proposal and the objectives that will accomplish the stated purpose. Each objective should be the single highest level of measurable achievement that can serve as a criterion for measuring the success or failure of the proposal.

d. Background. Present a brief historical overview of the proposal or preview work or theories that have led to the proposal.

e. Approach. Explain the management controls and methodology that will be used to execute the proposal in all fiscal years.

f. Technical Progress. Attach the last Technical

Progress Report if required by the program.

Also, describe the technical progress in BY-3 (the last complete fiscal year) and expected progress for BY-2, BY-1, and BY.

g. Future Accomplishments. Describe any anticipated benefits that will accrue in the future which are attributable to the proposal.

h. Relationship to Other Projects. Provide a description of any relationships, interrelationships, or dependencies which the proposal has with other known federally funded projects.

i. NEPA Considerations. In accordance with the

National Environmental Policy Act of 1969, describe the long-term and short-term potential impacts and effects of the work package upon the ecosystem and NEPA documentation that must be prepared.

j. Milestones (if applicable). A detailed explanation of the milestones presented on the second page of the proposal (item 20) should be given. For basic research, the only milestone may be the submission of a yearly progress report.

k. Deliverables. An itemized list of deliverables under the proposal excluding reports in item 21.

l. Performance Measures and Expectations. A description of the performance measures described as outcomes and the expectations for achieving those measures by which the success of the proposal will be measured.

m. ES&H Considerations. A description of the

ES&H hazards arising from performance of the proposed work and mitigating actions to protect the workers, the public, and the environment.

DOE WORK PROPOSAL INSTRUCTIONS CONTINUED

n. Human/Animal Subjects Research. Briefly describe any anticipated human subjects or animal subjects research activity that may occur as part of the proposed work.

o. Security Requirements. Identification of applicable security requirements.

p. Other. Any other attachments should be specified in the space provided on the work proposal form.

C. Page 2 of the Form—General. Header information on this page should be filled in as it appears on page 1. The “Authorized” column is not completed unless requested by the program when funds have been authorized. The column heading designations on page 2 of the

DOE/NNSA Work Proposal form are defined below. The relationship between the fiscal years

(FYs) and budget years (BYs) for which information is being provided is illustrated in the table…