Disclosure of Prior DFC Funding.docx

This is a required disclosure form for applicants to the Drug-Free Communities (DFC) Support Program Grant (CFDA 93.276), administered by the Department of Health and Human Services Centers for Disease Control and Prevention. The form requires applicants to disclose whether their coalition has previously received DFC funding and, if so, to provide comprehensive details about all prior awards.

Applicants must complete a checklist indicating whether their coalition has no prior DFC funding or has received DFC funding for a specified number of years. For coalitions with prior funding history, applicants must complete a disclosure table listing all previous awards, including the fiscal year(s) of funding, DFC grant award numbers, names of current and former fiscal agents, coalition name and state, and names of key personnel (Program Director/Principal Investigator and Project Coordinator). The form must be signed and dated by the legal applicant with their title and organization/agency information. This disclosure applies to both new applicants and those seeking continuation funding, as the DFC program distinguishes between new coalitions and those with established funding histories under the program's five-year cooperative agreement structure.