_2_-_Appendix_A-E_OST.pdf

Appendix A:

Budget Summary

BUDGET SUMMARY ( Example)

From To (Performance Period)

Proposed Project Cost

A: To tal Pro je ct

Cost

B: Com pan y/ U ni versi t y

Contr i bu t i on

C: N AS A

Contr i but i on

Direct Labor:

(salaries, wages, fringe benefits)

$6.00 $4.00 $2.00

Other Direct Costs:

Subcontracts

Consultants Cost pf Equipment use Supplies/consumables Materials Travel Other (describe) Other Other

$4.00

$1.00

$2.00

$1.00

Facilities & Administrative Overhead Costs:

$1.00 $1.00 $0.00

Other Applicable Costs (describe):

A. Example:

B. Cash contributions from NASA to company/university (e.g., Grad student tuition Company labor)

$0.00

SUBTOTAL – Estimated Costs: $17.00 $9.00 $8.00

TOTAL BUDGET: $17.00 $9.00 $8.00

Instructions

1. Provide a completed budget summary sheet for the Project performance period.

2. Recipient’s total estimated project costs should be entered in Column A. Columns B shall reflect the amount of the project cost to be contributed by the company/university and Column C shall reflect the amount of the cost to be contributed by NASA.

3. Provide as attachments detailed computations of estimates in each cost category with narratives required to fully explain proposed costs. See page, A-2, Appendix A

NOTICE: INFORMATION CONTAINED ON THIS FORM IS NOT TO BE RELEASED

OUTSIDE OF THE GOVERNMENT WITHOUT THE EXPRESS WRITTEN CONSENT OF THE

RECIPIENT.

Page A-1 NASA SBU – FOIA Exempt (Acquisition Sensitive)

Appendix A:

Budget Summary, Continued

SPECIFIC COSTS

1. Direct Labor (salaries, wages, and fringe benefits): Attachments shall list number and titles of personnel, amounts of time to be devoted to the grant, and rates of pay.

2. Other Direct Costs:

a. Subcontracts: Attachments shall describe the work to be subcontracted, estimated amount, offeror (if known), and the reason for subcontracting.

b. Consultants: Identify consultants to be used, why they are necessary, the time they will spend on the project, and rates of pay.

c. Equipment: List separately. Explain the need for items costing more than $5,000, unless a lower threshold has been established by your institution for classifying such purchases as equipment. Describe the basis for estimated cost. General purpose equipment is not allowable as a direct cost unless specifically approved by the grant officer. Any equipment purchase requested to be made as a direct charge under this grant shall include the equipment description, how it will be used in the conduct of the basic research proposed, why it cannot be purchased with indirect funds, and a statement certifying that the equipment will be used exclusively for research and not for general business or administrative purposes.

d. Supplies/materials: Provide the general description of needed supplies or materials, the method of acquisition and the estimated cost.

e. Travel: Describe the purpose of the proposed travel in relation to the agreement and provide the basis of the estimate, including information on destination and number of travelers where known.

f. Other: Enter the total of direct costs not covered by 2a through 2e. Attach an itemized list explaining the need for each item and the basis for the estimate.

3. Facilities and Administrative (F&A) Costs: Identify F&A cost rate(s) and base(s) including the effective period of the rate.

4. Other Applicable Costs: Enter total, explaining the need for each item.

a) If applicable, include any NASA cash contributions to the partner. Describe the items and associated costs covered by the cash contribution.

Page A-2

Appendix B:

Example of Milestone Costing Schedule

Required if NASA is providing a direct cash resource contribution of the Offeror

Date or NASA funding to Milestones *Time (end of) Offeror ($)

A. Kickoff meeting 1 week 2,000

B. Preliminary Design 5 weeks 7,000

C. Materials Procurement 9 weeks 5,000

D. Fabrication of Prototype I 15 weeks 15,000

E. Testing of Prototype, I 22 weeks 8,000

F. Modification and Fabrication of Prototype II 29 weeks 10,000 G. Closeout Briefing, Delivery of Prototype II 39 weeks 5,000 and all final reporting requirements

Total NASA Funding $52,000

*-Time, in weeks, from effective date of agreement.

Page B-1

Appendix C:

Cooperative Agreement Collaboration Statement

The Cooperative Agreement Collaboration Statement is a mutually agreed-upon list which summarizes the project responsibilities and contributions of both parties. The Offeror is expected to provide the description of the NASA responsibilities and contributions as well as their own. This Collaboration Statement will be included as a part of the final cooperative agreement content. The Collaboration Statement shall include the following:

Project Title: Project Name

Project Objective: Provide a concise summary description of the objective(s) of the project.

NASA/GSFC shall be responsible for the following contributions to the joint activity:

1. Numerically list NASA/GSFC’s significant responsibilities/contributions for the project.

2.

(Name of Offeror organization) shall be responsible for the following contributions to the joint activity:

1. Numerically list the Offeror organization’s significant responsibilities/contributions for the project.

2.

Where relevant, Tasks listed should include a reference to the corresponding Technical Schedule/Milestone(s).

See Page C-2 for an example of the Collaboration Statement.

Page C-1

Appendix C:

Example

Project Title: “The Design, Development, and Test of XYZ Prototype”

Project Objective: The primary object of the project is to design, develop, and test a prototype unit. The performance test results of the developed XYZ prototype will be analyzed against performance objectives, and the analysis results and conclusions shall be provided in a closeout briefing.

NASA MSFC shall be responsible for the following contributions to the joint activity:

1. GSFC will provide engineering consultation and support to (Offeror name) for the development efforts for the XYZ Prototype unit

2. GSFC will provide sample materials to (Offeror name) for prototype development NLT Milestone C of the technical Schedule

3. GSFC will develop the prototype test plans and test procedures 1week s prior to the test start date.

4. GSFC will perform the testing of the developed prototype using the GSFC XXXX & YYYY test facilities. Testing will be complete at Milestone E.

5. GSFC will...

(Offeror name) shall be responsible for the following contributions to the joint activity:

1. (Offeror name) will design and build the XYZ prototype during Technical Schedule Milestones B-D.

2. (Offeror name) will work with MSFC to develop the prototype test plans and test procedures, and will observe the MSFC testing of the XYZ prototype (Milestone E)

3. (Offeror name) will perform the data analysis on the performance test results within 2 weeks after test completion.

4. (Offeror name) will ...

5. (Offeror name) will provide a final report detailing the XYZ prototype development and the results of the performance test at Milestone G

Page C-2

Appendix E:

Certifications, Assurances, and Representations

Certifications, Assurances, and Representations

Certification of Compliance on Proposal Cover Page

By submitting the proposal identified in the Cover Sheet/Proposal Summary in response to this CAN, the

Authorizing Official of the proposing organization as identified below:

certifies that the statements made in this proposal are true and complete to the best of his/her knowledge;

agrees to accept the obligation to comply with NASA award terms and conditions if an award is made as a result of this proposal; and confirms compliance with all applicable provisions, rules, and stipulations set forth in the Certifications, Assurances, and Representations contained in this NRA or CAN. Willful provision of false information in this proposal and/or its supporting documents, or in reports required under an ensuing award, is a criminal offense (U.S. Code, Title 18, Section 1001).

Assurance of Compliance with the National Aeronautics and Space Administration Regulations Pursuant to Nondiscrimination in Federally Assisted Programs

“The Organization, corporation, firm, or other organization on whose behalf this assurance is made, hereinafter called "Applicant,"

“HEREBY acknowledges and agrees that it must comply (and require any subgrantees, contractors, successors, transferees, and assignees to comply) with applicable provisions of national laws and policies prohibiting discrimination, including but not limited to:

Title VI of the Civil Rights Act of 1964, as amended, which prohibits recipients of federal financial assistance from discriminating on the basis of race, color, or national origin (42 U.S.C. 2000d et seq.), as implemented by NASA Title VI regulations, 14 C.F.R. Part 1250.

As clarified by Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting agency guidance, national origin discrimination includes discrimination on the basis of limited English proficiency (LEP). To ensure compliance with Title VI, the Applicant must take reasonable steps to ensure that LEP persons have meaningful access to its programs in accordance with

NASA Title VI LEP Guidance to Grant Recipients (68 Fed. Reg. 70039). Meaningful access may entail providing language assistance services, including oral and written translation, where necessary. The

Applicant is encouraged to consider the need for language services for LEP persons served or encountered both in developing budgets and in conducting programs and activities. Assistance and information regarding LEP obligations may be found at http://www.lep.gov.

Title IX of the Education Amendments of 1972, as amended, which prohibits discrimination on the basis of sex in education programs or activities (20 U.S.C. 1681 et seq.) as implemented by NASA Title IX regulations, 14 C.F.R. Part 1253. If the Applicant is an educational institution:

The Applicant is required to designate at least one employee to serve as its Title IX coordinator (14

C.F.R. § 1253.135(a)).

The Applicant is required to notify all of its program beneficiaries of the name, office, address, and telephone number of the employee(s) designated to serve as the Title IX coordinators. (14 C.F.R.

§1253.135(a)).

The Applicant is required to publish internal grievance procedures to promptly and equitably resolve complaints alleging illegal discrimination in its programs or activities (14 C.F.R. §1253.135(b).

http://www.lep.gov/

The Applicant is required to take specific steps to regularly and consistently notify program beneficiaries that The Applicant does not discriminate in the operation of its programs and activities. (14 C.F.R. §1253.140).

Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits The Applicant from discriminating on the basis of disability (29 U.S.C. 794) as implemented by NASA Section 504 regulations, 14 C.F.R. Part 1251.

a. The Applicant is required to designate at least one employee to serve as its Section 504 coordinator (14 C.F.R. §1251.106(a)).

b. The Applicant is required to notify all its program beneficiaries of the name, office, address, and telephone number of the employee(s) designated to serve as the Section 504 coordinator (14

C.F.R. §1251.106(a)).

c. The Applicant is required to publish internal grievance procedures to promptly and equitably resolve complaints alleging illegal discrimination in its programs or activities (14 C.F.R.

§1251.106(b)).

d. The Applicant is required to take specific steps to regularly and consistently notify program beneficiaries that the Applicant does not discriminate in the operation of its programs and activities. (14 C.F.R. §1251.107).

The Age Discrimination Act of 1975, as amended, which prohibits the Applicant from discriminating on the basis of age (42 U.S.C. 6101 et seq.) as implemented by NASA Age Discrimination Act regulations, 14 C.F.R. Part 1252.

The Applicant also acknowledges and agrees that it must cooperate with any compliance review or complaint investigation conducted by NASA and comply (and require any subgrantees, contractors, successors, transferees, and assignees to comply) with applicable provisions governing NASA access to records, accounts, documents, information, facilities, and staff. The Applicant must keep such records and submit to the responsible NASA official or designee timely, complete, and accurate compliance reports at such times, and in such form and containing such information, as the responsible NASA official or his designee may determine to be necessary to ascertain whether the Applicant has complied or is complying with relevant obligations and must immediately take any measure determined necessary to effectuate this agreement. The Applicant must comply with all other reporting, data collection, and evaluation requirements, as prescribed by law or detailed in program guidance.

The United States shall have the right to seek judicial enforcement of these obligations. This assurance is binding on the Applicant, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign on behalf of the Applicant.”

Under penalty of perjury, the undersigned officials certify that they have read and understand their obligations as herein described, that the information submitted in conjunction with this document is accurate and complete, and that the recipient is in compliance with the nondiscrimination requirements set out above.

Certification Regarding Lobbying

“No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any

Federal contract, grant, loan, or cooperative agreement.

“If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to

Report Lobbying," in accordance with its instructions.

“The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

“This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000, and not more than $100,000 for each such failure.”

Certification Regarding Debarment, Suspension, and Other Responsibility Matters

“Pursuant to Executive Order 12549, Debarment and Suspension, and implemented at 2 CFR Parts 180 and

1880:

(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

(a) ) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

(b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statues or commission of embezzlement theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) ) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity

(Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and

(d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause or default.”

“(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.”

Assurance and Representation on China Restrictions

By submission of its proposal, the proposer represents that the proposer is not China or a Chinese-owned company, and that the proposer will not participate, collaborate, or coordinate bilaterally with China or any

Chinese-owned company, at the prime recipient level or at any subrecipient level, whether the bilateral involvement is funded or performed under a no-exchange of funds arrangement.

Certification of Tax Compliance

For awards exceeding $5 million, proposer certifies it has filed the Federal tax returns required during the three years preceding this certification, has not been convicted of a criminal offense under the Internal revenue Code of 1986, and has not, more than 90 days prior to certification, been notified of any unpaid Federal tax assessment for which the liability remains unsatisfied, unless the assessment is the subject of an installment agreement or offer in compromise that has been approved by the Internal Revenue Service and is not in default, or the assessment is the subject of a non-frivolous administrative or judicial proceeding.

Representation Regarding Corporate Felony Convictions

If a corporation, the prospective recipient represents that it has not been convicted, or had an officer or agent acting on behalf of the corporation convicted, of a felony criminal violation under a Federal law within the preceding 24 months.

Representation Regarding Unpaid Corporate Tax Liabilities

If a corporation, the prospective recipient represents that it has no unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; unless an agency has considered suspension or debarment of the corporation and made a determination that this further action is not necessary to protect the interests of the Government.

Representation Regarding Restrictions on Reporting Waste, Fraud, and Abuse

The prospective recipient represents that it does not and will not require employees or its contractors—who seek to report fraud, waste, or abuse—to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or contractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a federal department or agency authorized to receive such information.

Note: Procurement personnel may obtain updates at time of award if needed. Procurement personnel will also obtain any outdated certifications needed on an annual basis (e.g., at time of annual funding).

Appendix F:

Origins Space Telescope Decadal Mission Study Schedule

(Top-Level)